The cross-talk between prolactin and growth hormone in pituitary adenomas

Coexisting hyperprolactinemia and growth hormone (GH) excess in patients with pituitary adenomas occur in several case scenarios, including tumoral co-secretion of prolactin and GH, stalk effect or medication-induced hyperprolactinemia, and analytical laboratory issues. A correct diagnosis can sometimes be challenging, requiring a thorough clinical, biochemical and radiological evaluation. Despite a recent increase in publications in this field, standardized criteria to define co-secreting GH-prolactin adenomas have not been established. For patients undergoing surgery, several distinct histopathological subtypes of co-secreting pituitary adenomas have been described; however, their prognostic implications remain to be determined. In this review, we summarize the current knowledge regarding presentation and therapeutic outcomes of co-secreting GH-prolactin pituitary adenomas, and provide management recommendations for patients exhibiting biochemical excess of prolactin and GH levels.