[Refractory pituitary prolactinoma:current treatment status and challenges]

Pituitary prolactinoma is the most common functioning pituitary adenoma in clinical practice. Hypogonadotropic hypogonadism secondary to hyperprolactinemia is the main clinical manifestation of patients. Most patients respond well to dopamine receptor agonists (DA). The patients with DA resistance and pituitary tumor apoplexy need neurosurgical treatment. Neurosurgery also increasingly applied to non-invasive microadenoma patients. Radiotherapy is an effective adjuvant treatment method. However, 10%-15% of prolactinoma patients develop refractory pituitary tumors and even progress to metastatic pituitary neuroendocrine tumors (pituitary cancer), seriously affecting the quality of life and even lifespan of patients. This article systematically reviews the definition evolution, molecular mechanism, early predictive markers, and the latest treatment progress of refractory pituitary prolactinoma. It is also suggested that the diagnosis and treatment level of refractory pituitary prolactinoma be gradually improved through the exploration and application of precision medicine and the promotion of standardized multidisciplinary collaborative diagnosis and treatment models.