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Management of medically refractory prolactinoma
1Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, 645 N. Michigan Avenue, Suite 530, Chicago, IL, 60611, USA, molitch@northwestern.edu.
Journal of Neuro-Oncology
|October 23, 2013
Summary
Dopamine agonist resistance in macroprolactinoma occurs in 10-35% of patients. Treatment options include switching agonists, dose adjustments, surgery, or fertility/hormone therapies.
Area of Science:
- Endocrinology
- Oncology
Background:
- Dopamine agonists are first-line treatment for macroprolactinomas.
- Resistance is defined by lack of prolactin normalization or tumor shrinkage.
Purpose of the Study:
- To review treatment strategies for dopamine agonist-resistant macroprolactinomas.
Main Methods:
- Review of existing literature on dopamine agonist resistance and management.
- Analysis of treatment outcomes for various therapeutic approaches.
Main Results:
- Bromocriptine resistance rates: 25% for prolactin, 33% for tumor size.
- Cabergoline resistance rates: 10-15% for prolactin, 10-15% for tumor size.
- Alternative treatments include dose escalation, switching agonists, surgery, and fertility-focused therapies.
Conclusions:
- Multiple therapeutic avenues exist for dopamine agonist-resistant macroprolactinomas.
- Treatment choice depends on patient-specific factors like fertility desires and tumor characteristics.
- Experimental therapies like temozolomide offer options for refractory cases.
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