Journal Article

Management of resistant prolactinomas

Olafsdottir, Agusta, Schlechte, Janet

2006

Overview

This Review details treatment of prolactinomas that do not respond to dopamine agonists. Cabergoline is the most effective agonist and options include maximizing the dose and changing agonists. Trans-sphenoidal surgery is an option if medical therapy is ineffective. Radiation therapy is reserved for invasive tumors that do not respond to medical or surgical therapy. Resistance to dopamine agonists occurs in a subset of patients with prolactin-secreting pituitary tumors. The resistance is mediated by loss of pituitary D 2 receptors and occurs in both microadenomas and macroadenomas. Cabergoline is the most effective dopamine agonist and tumors that do not respond to bromocriptine or quinagolide frequently respond to cabergoline. Treatment options include maximizing the dose of the dopamine agonist, changing agonists, trans-sphenoidal surgery and radiation therapy. The goal of therapy is to restore and maintain gonadal and neurologic function, and this might occur in the absence of a normal prolactin level or a significant change in tumor size. Trans-sphenoidal pituitary surgery should be reserved for patients who are intolerant of medical therapy, or in whom this has failed. Radiation therapy has a limited role in treatment of resistant prolactinomas and should be reserved for patients in whom medical and surgical therapy has failed. Key Points 10–20% of patients with microprolactinomas and 20–30% of patients with macroadenomas demonstrate resistance to a dopamine agonist Treatment might restore and maintain gonadal and neurologic function without normalization of prolactin levels or a change in tumor size Tumors resistant to bromocriptine or quinagolide frequently respond to cabergoline Trans-sphenoidal surgery should be reserved for treatment of patients who are intolerant of medical therapy, or in whom this has failed

• Publisher: Nature Publishing Group UK,Nature Publishing Group
• Subject: Dopamine / Dopamine Agonists - therapeutic use / Drug Resistance, Neoplasm - drug effects / Drug Resistance, Neoplasm - radiation effects / Endocrinology / Humans / Internal medicine / Medicine / Medicine & Public Health / Metabolism / Pituitary Neoplasms - drug therapy / Pituitary Neoplasms - radiotherapy / Pituitary Neoplasms - surgery / Pituitary Neoplasms - therapy / Prolactinoma - drug therapy / Prolactinoma - radiotherapy / Prolactinoma - surgery / Prolactinoma - therapy / Radiation therapy / review-article / Surgery / Tumors