Prolactin-secreting adenomas: pathogenesis, diagnosis, and management

Area of Science:

• Endocrinology
• Oncology
• Neurosurgery

Background:

• Hyperprolactinemia stems from physiological, pharmacological, or pathological causes, including pituitary adenomas.
• Prolactin-secreting pituitary adenomas (prolactinomas) are the most common functioning pituitary tumors, with distinct characteristics in men and women.
• Diagnosis involves immunostaining for prolactin, pituitary-specific positive transcription factor 1, and estrogen receptor α.

Purpose of the Study:

• To review the pathogenesis, diagnosis, and management of prolactinomas.
• To assess current therapeutic strategies and identify future research directions.

Main Methods:

• Literature review of evidence on prolactinoma pathogenesis, diagnosis, and treatment.
• Analysis of treatment outcomes for dopamine agonists, surgery, and radiotherapy.

Main Results:

• Dopamine agonists, especially cabergoline (up to 2.0 mg/week), normalize prolactin, shrink tumors (≥30%), and restore gonadal function in most patients within 6 months.
• Transsphenoidal surgery provides high remission rates for small prolactinomas and is an option for drug-intolerant or resistant cases.
• Radiotherapy is reserved for refractory prolactinomas.

Conclusions:

• Multidisciplinary and individualized management optimizes outcomes for prolactinomas.
• Dopamine agonists and surgery are primary therapies, with radiotherapy for refractory cases.
• Further research is needed to advance prolactinoma management.