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Updated: Aug 6, 2025
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Refractory lactotroph adenomas
Sandrine A Urwyler1,2,3, Niki Karavitaki4,5,6
1Institute of Metabolism and Systems Research (ISMR), College of Medical and Dental Sciences, University of Birmingham, IBR Tower, Level 2, Birmingham, B15 2TT, UK.
Abstract:
A small subset of lactotroph adenomas is resistant to dopamine agonists (DA) and can also demonstrate aggressive or even malignant behavior. The implicated mechanisms are not clearly defined. Management can be challenging and requires a multidisciplinary approach. In DA resistant prolactinomas, switching to another DA could be the first option to consider. Further strategies include surgery and radiotherapy used alone or in combination. In cases of aggressive or malignant prolactinomas, temozolomide could be offered. Immune checkpoint inhibitors have been also recently proposed as an alternative approach. The place of other treatments (e.g., metformin, selective estrogen modulators, somatostatin analogues, tyrosine kinase inhibitors, inhibitors of mammalian target of rapamycin and peptide radio-receptor therapy) remains to be carefully assessed.
Insights
Dopamine agonist-resistant prolactinomas require tailored management, including alternative treatments like temozolomide or immune checkpoint inhibitors for aggressive cases. Further research is needed to assess other therapeutic options for these challenging tumors.
Area of Science:
- Endocrinology
- Oncology
- Pituitary Disorders
Background:
- A subset of prolactinomas, a type of pituitary tumor, exhibit resistance to dopamine agonists (DA).
- These resistant adenomas can display aggressive or malignant behavior, posing significant management challenges.
- The underlying mechanisms of DA resistance and aggressive behavior are not fully understood.
Purpose of the Study:
- To review current management strategies for dopamine agonist-resistant prolactinomas.
- To discuss therapeutic options for aggressive and malignant prolactinomas.
- To highlight the need for further research into novel treatment modalities.
Main Methods:
- Literature review of studies on prolactinoma management.
- Analysis of treatment outcomes for resistant and aggressive pituitary adenomas.
- Discussion of emerging therapeutic approaches.
Main Results:
- Switching to alternative dopamine agonists is a primary strategy for DA-resistant prolactinomas.
- Surgery and radiotherapy are established options, often used in combination.
- Temozolomide and immune checkpoint inhibitors show promise for aggressive or malignant cases.
Conclusions:
- Management of DA-resistant prolactinomas necessitates a multidisciplinary approach.
- Established treatments include alternative DAs, surgery, and radiotherapy.
- Emerging therapies like temozolomide and immune checkpoint inhibitors offer new hope, with other treatments requiring further evaluation.
