Prolactinoma — possible change in treatment approach? — review of the literature

Streszczenie

A recent Pituitary Society consensus statement provided clinical recommendations for
diagnosing and managing prolactin-secreting pituitary adenomas, known as prolactinomas.
Prolactinomas are rare, usually benign tumours of the anterior pituitary gland that
result in excessive prolactin production, or hyperprolactinemia. Despite being non-life-
-threatening, patients often prompt medical attention due to symptoms stemming from
elevated prolactin levels, such as reproductive and sexual dysfunction, e.g. menstrual
irregularities, galactorrhoea, infertility, or from mass effects like headaches, cranial nerve
palsies, and vision problems. Laboratory testing showing hyperprolactinemia and low sex
hormone levels is used for diagnosis. Unlike other pituitary tumours, the primary treatment
for prolactinomas is typically pharmacological therapy with dopamine agonists. However, for
patients with smaller tumours (microprolactinomas) or well-circumscribed larger tumours
(macroprolactinomas), surgery may be considered the first-line option. It is a surprising
shift in the therapeutic strategy. For patients resistant to dopamine agonists, alternative
strategies include switching medications, increasing dosages, or pursuing neurosurgery or
radiotherapy. The key treatment goals are to normalize prolactin levels, restore reproductive
and sexual function, and reduce tumour size. This review aimed to provide clinicians with
an up-to-date overview of diagnostics and treatment options for patients with prolactin-
-secreting pituitary adenomas, as well as highlight the potential diagnostic challenges and
complexity of treatment.