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Caprio S, Pilli T, Cantara S, Sestini F, Fioravanti C, Ciuoli C, Dalmiglio C, Corbo A, Castagna MG. Paradoxical effect of dopamine-agonists on IGF-1 in patients with prolactinoma: the role of weight. BMC Endocr Disord 2024; 24:94. [PMID: 38902646 PMCID: PMC11188517 DOI: 10.1186/s12902-024-01622-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 06/11/2024] [Indexed: 06/22/2024] Open
Abstract
PURPOSE An increase of IGF-1 has been reported during therapy with dopamine agonists (DA) for prolactinomas; in such cases a correct diagnosis is pivotal to avoid an unnecessary reduction or withdrawal of DA, which are needed to maintain normal prolactin levels. This study was aimed to measure IGF-1 levels, at baseline and during follow-up, in a cohort of patients with prolactinoma, treated with cabergoline, stratified by body mass index. METHODS We retrospectively enrolled 35 patients (15 F/20 M; age m ± SD, years: 43.4 ± 13.7) with prolactinoma (21 microadenomas and 14 macroadenomas) who were followed-up at the Endocrinology Unit, in Siena, and with available pituitary hormone assessment at baseline and during follow-up (m ± SD, years: 2.74 ± 0.55). RESULTS IGF-1 increased in the whole cohort, but remaining within normal range, except two patients, in whom acromegaly was ruled out with oral glucose tolerance test. After dividing patients by weight, this trend was confirmed only in subjects with overweight and obesity (OV/OB) (p = 0.04). Interestingly, the reduction of prolactin levels was significantly greater in the OV/OB compared to normal-weight patients (median decrease of 97.5% versus 88.2%, p = 0.04). CONCLUSIONS Since DA and normalization of prolactin are known to improve insulin sensitivity, we speculated they have favored the increase of IGF-1 in OV/OB. Our results should be confirmed and the hypothesis proven by further studies.
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Affiliation(s)
- S Caprio
- Section of Endocrinology, Department of Medical, Surgical and Neurogical Sciences, University of Siena, Siena, Italy
| | - T Pilli
- Section of Endocrinology, Department of Medical, Surgical and Neurogical Sciences, University of Siena, Siena, Italy
| | - S Cantara
- Section of Endocrinology, Department of Medical, Surgical and Neurogical Sciences, University of Siena, Siena, Italy
- Laboratory of Clinical and Translational Research, University of Siena, Siena, Italy
| | - F Sestini
- Section of Endocrinology, Department of Medical, Surgical and Neurogical Sciences, University of Siena, Siena, Italy
- Laboratory of Clinical and Translational Research, University of Siena, Siena, Italy
| | - C Fioravanti
- Section of Endocrinology, Department of Medical, Surgical and Neurogical Sciences, University of Siena, Siena, Italy
- Laboratory of Clinical and Translational Research, University of Siena, Siena, Italy
| | - C Ciuoli
- Section of Endocrinology, Department of Medical, Surgical and Neurogical Sciences, University of Siena, Siena, Italy
| | - C Dalmiglio
- Section of Endocrinology, Department of Medical, Surgical and Neurogical Sciences, University of Siena, Siena, Italy
| | - A Corbo
- Section of Endocrinology, Department of Medical, Surgical and Neurogical Sciences, University of Siena, Siena, Italy
| | - M G Castagna
- Section of Endocrinology, Department of Medical, Surgical and Neurogical Sciences, University of Siena, Siena, Italy.
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Corona G, Rastrelli G, Bianchi N, Sparano C, Sforza A, Vignozzi L, Maggi M. Hyperprolactinemia and male sexual function: focus on erectile dysfunction and sexual desire. Int J Impot Res 2024; 36:324-332. [PMID: 37340146 DOI: 10.1038/s41443-023-00717-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 04/03/2023] [Accepted: 05/02/2023] [Indexed: 06/22/2023]
Abstract
The present paper aims to analyze and discuss the available evidence supporting the relationship between male sexual function and elevated prolactin (PRL) levels (HPRL). Two different sources of data were analyzed. Clinical data were derived from a series of patients seeking medical care for sexual dysfunction at our Unit. Out of 418 studies, 25 papers were used with a meta-analytic approach to evaluate the overall prevalence of HPRL in patients with erectile dysfunction (ED) and to study the influence of HPRL and its treatment on male sexual function. Among 4215 patients (mean age 51.6 ± 13.1 years) consulting for sexual dysfunction at our Unit, 176 (4.2%) showed PRL levels above the normal range. Meta-analytic data showed that HPRL is a rare condition among patients with ED (2 [1;3]%). Either clinical and meta-analytic data confirm a stepwise negative influence of PRL on male sexual desire (S = 0.00004 [0.00003; 0.00006]; I = -0.58915 [-0.78438; -0.39392]; both p < 0.0001 from meta-regression analysis). Normalization of PRL levels is able to improve libido. The role of HPRL in ED remains inconclusive. Data from a meta-analytic approach showed that either HPRL or reduced T levels were independently associated with ED rates. The normalization of PRL levels only partially restored ED. HPRL did not significantly contribute to ED severity, in our clinical setting. In conclusion, treating HPRL can restore normal sexual desire, whereas its effect on erection is limited.
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Affiliation(s)
- G Corona
- Endocrinology Unit, Maggiore-Bellaria Hospital, Medical Department, Azienda-Usl Bologna, Bologna, Italy.
| | - G Rastrelli
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | - N Bianchi
- Endocrinology Unit, Maggiore-Bellaria Hospital, Medical Department, Azienda-Usl Bologna, Bologna, Italy
| | - C Sparano
- Endocrinology Unit Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | - A Sforza
- Endocrinology Unit, Maggiore-Bellaria Hospital, Medical Department, Azienda-Usl Bologna, Bologna, Italy
| | - L Vignozzi
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | - M Maggi
- Endocrinology Unit Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
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Chen Z, Shou X, Ji L, Cheng H, Shen M, Ma Z, He W, Ye Z, Zhang Y, Qiao N, Zhang Q, Wang Y. Presurgical Medical Treatment in Prolactinomas: Surgical Implications and Pathological Characteristics From 290 Cases. J Clin Endocrinol Metab 2024; 109:1433-1442. [PMID: 38163969 DOI: 10.1210/clinem/dgad758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/30/2023] [Accepted: 12/26/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE To review experience regarding the treatment of prolactinomas by endoscopic endonasal surgery focusing on the association between presurgical dopamine agonist (DA) treatment and perioperative outcomes, surgical morbidities, endocrine outcomes, and pathological characteristics. METHODS A single-center series of 290 cases was analyzed retrospectively and clinical data were collected. Intratumoral collagen content was assessed by Masson trichrome staining. RESULTS Tenacious tumor consistency (27.8% vs 9.8%, P < .001) was more common in DA-pretreated patients compared with patients who underwent initial surgery. Moreover, DA-pretreated macroadenomas presented more intraoperative blood loss (200 [100-400] mL vs 175 [100-300] mL; P = .014), longer surgical duration (177 ± 95 minutes vs 154 ± 57 minutes; P = .043), and more surgical morbidities (19.4% vs 8.9%; P = .034). Additionally, DA-pretreated macroadenomas presented a higher collagen volume fraction than that of the initial surgery group (23.6 ± 2.2% vs 13.2 ± 2.1%; P = .001). Correlation analysis revealed a close correlation between collagen volume fraction and the cumulative dose of bromocriptine (BRC) in macroadenomas (r = 0.438, P < .001). Regarding endocrine outcomes, DA-pretreated microadenomas showed a lower proportion of initial remission compared with patients who underwent initial surgery (86.7% vs 100%, P = .047). CONCLUSION This study described increased surgical difficulty and inferior endocrine outcomes associated with tumor fibrosis secondary to presurgical BRC treatment in prolactinomas. Neurosurgeons should note that presurgical BRC treatment may render subsequent surgery more challenging.
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Affiliation(s)
- Zhengyuan Chen
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China
- National Center for Neurological Disorders, Shanghai 200040, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai 201100, China
- Neurosurgical Institute of Fudan University, Shanghai 200040, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai 200040, China
| | - Xuefei Shou
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China
- National Center for Neurological Disorders, Shanghai 200040, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai 201100, China
- Neurosurgical Institute of Fudan University, Shanghai 200040, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai 200040, China
| | - Lijin Ji
- Department of Endocrinology and Metabolism, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China
| | - Haixia Cheng
- Department of Pathology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China
| | - Ming Shen
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China
- National Center for Neurological Disorders, Shanghai 200040, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai 201100, China
- Neurosurgical Institute of Fudan University, Shanghai 200040, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai 200040, China
| | - Zengyi Ma
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China
- National Center for Neurological Disorders, Shanghai 200040, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai 201100, China
- Neurosurgical Institute of Fudan University, Shanghai 200040, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai 200040, China
| | - Wenqiang He
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China
- National Center for Neurological Disorders, Shanghai 200040, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai 201100, China
- Neurosurgical Institute of Fudan University, Shanghai 200040, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai 200040, China
| | - Zhao Ye
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China
- National Center for Neurological Disorders, Shanghai 200040, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai 201100, China
- Neurosurgical Institute of Fudan University, Shanghai 200040, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai 200040, China
| | - Yichao Zhang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China
- National Center for Neurological Disorders, Shanghai 200040, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai 201100, China
- Neurosurgical Institute of Fudan University, Shanghai 200040, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai 200040, China
| | - Nidan Qiao
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China
- National Center for Neurological Disorders, Shanghai 200040, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai 201100, China
- Neurosurgical Institute of Fudan University, Shanghai 200040, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai 200040, China
| | - Qilin Zhang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China
- National Center for Neurological Disorders, Shanghai 200040, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai 201100, China
- Neurosurgical Institute of Fudan University, Shanghai 200040, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai 200040, China
| | - Yongfei Wang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China
- National Center for Neurological Disorders, Shanghai 200040, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai 201100, China
- Neurosurgical Institute of Fudan University, Shanghai 200040, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai 200040, China
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Affiliation(s)
- Zhe Bao Wu
- Department of Neurosurgery, Center of Pituitary Tumor, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Korbonits M, Blair JC, Boguslawska A, Ayuk J, Davies JH, Druce MR, Evanson J, Flanagan D, Glynn N, Higham CE, Jacques TS, Sinha S, Simmons I, Thorp N, Swords FM, Storr HL, Spoudeas HA. Consensus guideline for the diagnosis and management of pituitary adenomas in childhood and adolescence: Part 2, specific diseases. Nat Rev Endocrinol 2024; 20:290-309. [PMID: 38336898 DOI: 10.1038/s41574-023-00949-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 02/12/2024]
Abstract
Pituitary adenomas are rare in children and young people under the age of 19 (hereafter referred to as CYP) but they pose some different diagnostic and management challenges in this age group than in adults. These rare neoplasms can disrupt maturational, visual, intellectual and developmental processes and, in CYP, they tend to have more occult presentation, aggressive behaviour and are more likely to have a genetic basis than in adults. Through standardized AGREE II methodology, literature review and Delphi consensus, a multidisciplinary expert group developed 74 pragmatic management recommendations aimed at optimizing care for CYP in the first-ever comprehensive consensus guideline to cover the care of CYP with pituitary adenoma. Part 2 of this consensus guideline details 57 recommendations for paediatric patients with prolactinomas, Cushing disease, growth hormone excess causing gigantism and acromegaly, clinically non-functioning adenomas, and the rare TSHomas. Compared with adult patients with pituitary adenomas, we highlight that, in the CYP group, there is a greater proportion of functioning tumours, including macroprolactinomas, greater likelihood of underlying genetic disease, more corticotrophinomas in boys aged under 10 years than in girls and difficulty of peri-pubertal diagnosis of growth hormone excess. Collaboration with pituitary specialists caring for adult patients, as part of commissioned and centralized multidisciplinary teams, is key for optimizing management, transition and lifelong care and facilitates the collection of health-related quality of survival outcomes of novel medical, surgical and radiotherapeutic treatments, which are currently largely missing.
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Affiliation(s)
- Márta Korbonits
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
| | | | - Anna Boguslawska
- Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
| | - John Ayuk
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Justin H Davies
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Maralyn R Druce
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Jane Evanson
- Neuroradiology, Barts Health NHS Trust, London, UK
| | | | - Nigel Glynn
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Thomas S Jacques
- Great Ormond Street Institute of Child Health, University College London, London, UK
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Saurabh Sinha
- Sheffield Children's and Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Ian Simmons
- The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Nicky Thorp
- The Christie NHS Foundation Trust, Manchester, UK
| | | | - Helen L Storr
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Helen A Spoudeas
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- University College London Hospitals NHS Foundation Trust, London, UK
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Birtolo MF, Giannini E, Antonini S, Lavezzi E, Lasio G, Da Rin G, Mazziotti G, Lania AG. Prediction of adrenal insufficiency after pituitary surgery: a retrospective study using beckman access cortisol assay. Pituitary 2024; 27:160-168. [PMID: 38170374 DOI: 10.1007/s11102-023-01368-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/27/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE Identifying patients requiring glucocorticoid replacement therapy after pituitary surgery is challenging as the tests commonly used for the diagnosis of secondary adrenal insufficiency (SAI) are not recommended in the immediate postoperative period. There are controversial data on the role of postoperative days' morning cortisol, with no specific data for each cortisol assay. The aim of this study is to investigate the reliability of 8.00 a.m. cortisol of the first and second postoperative days in predicting SAI. METHODS Data of patients underwent pituitary surgery in Humanitas Research Hospital in Italy, from March 2017 to August 2022, were retrospectively analyzed. Definitive diagnosis of SAI was made through ACTH test 1 µg six weeks after surgery. Cortisol was measured through Beckman Access Cortisol and the diagnosis of SAI was made if cortisol peak was below 14.8 µg/dL (408 nmol/L) at 30 or 60 min after stimulus. RESULTS Of the sixty-four patients enrolled, seven developed SAI. The ROC curves demonstrated that both first- and second-day postoperative 8.00 a.m. cortisol predict SAI (AUC 0.94 and 0.95, respectively). The optimal thresholds were 15.6 µg/dL (430.3 nmol/L; accuracy 89%) for the first day and 11.5 µg/dL (317.2 nmol/L, accuracy 81%) for the second day. Patients who developed SAI had larger tumors (p = 0.004) and lower fT4 (p = 0.038) before surgery. CONCLUSIONS Clinicians might rely on the first- and second- postoperative days 8.00 a.m. cortisol to identify patients to discharge with glucocorticoid replacement therapy waiting for the confirmation of SAI through the ACTH test.
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Affiliation(s)
- Maria Francesca Birtolo
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
- Endocrinology, Diabetology and Medical Andrology Unit, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Emma Giannini
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
| | - Simone Antonini
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
- Endocrinology, Diabetology and Medical Andrology Unit, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Elisabetta Lavezzi
- Endocrinology, Diabetology and Medical Andrology Unit, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Giovanni Lasio
- Department of Neurosurgery, IRCCS Humanitas Clinical and Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Giorgio Da Rin
- Laboratory Medicine, IRCCS Humanitas Clinical and Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Gherardo Mazziotti
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy.
- Endocrinology, Diabetology and Medical Andrology Unit, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy.
| | - Andrea G Lania
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
- Endocrinology, Diabetology and Medical Andrology Unit, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
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Miao X, Fu Z, Luo X, Wang J, Yuan L, Zhao S, Feng Y, Huang S, Xiao S. A study on the correlations of PRL levels with anxiety, depression, sleep, and self-efficacy in patients with prolactinoma. Front Endocrinol (Lausanne) 2024; 15:1369729. [PMID: 38572480 PMCID: PMC10989272 DOI: 10.3389/fendo.2024.1369729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 02/29/2024] [Indexed: 04/05/2024] Open
Abstract
Purpose The purpose of this study was to explore the factors influencing PRL levels in patients with prolactinoma and to investigate the correlations between anxiety, depression, sleep, self-efficacy, and PRL levels. Methods This retrospective study included 176 patients with prolactinoma who received outpatient treatment at the Affiliated Hospital of Zunyi Medical University from May 2017 to August 2022. The general information questionnaire, Hospital Anxiety and Depression Scale (HADS), Athens Insomnia Scale (AIS), and General Self-Efficacy Scale (GSES) were used for data collection. A generalized estimating equation (GEE) model was used to analyze the factors influencing PRL levels in patients with prolactinoma. GEE single-effect analysis was used to compare PRL levels at different time points between anxiety group and nonanxiety group, between insomnia group and normal group, and between low, medium, and high self-efficacy groups. Results The median baseline PRL level and the PRL levels at 1, 3, 6, and 12 months of follow-up were 268.50 ng/ml, 122.25 ng/ml, 21.20 ng/ml, 19.65 ng/ml, and 16.10 ng/ml, respectively. Among patients with prolactinoma, 59.10% had anxiety (HADS-A score = 7.35 ± 3.34) and 28.98% had depression (HADS-D score = 5.23 ± 3.87), 9.10% had sleep disorders (AIS score = 6.10 ± 4.31) and 54.55% had low self-efficacy (GSES score = 2.13 ± 0.83). Educational level, tumor size, number of visits, sleep quality, anxiety level, and self-efficacy level were found to be factors influencing PRL levels in patients with prolactinoma (P<0.05). Higher PRL levels were observed in the anxiety group compared to the non-anxiety group (P<0.001), in the insomnia group compared to the normal group (P<0.05), and in the low self-efficacy group compared to the medium and high self-efficacy groups (P<0.05). Conclusion PRL levels in patients with prolactinoma are related to education level, tumor size, number of visits, anxiety, self-efficacy, and sleep but not depression. PRL levels were higher in patients with anxiety, low self-efficacy, and sleep disorders.
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Affiliation(s)
- Xiaoju Miao
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- The First Ward of the Neurosurgery Department, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Zhongmin Fu
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- The First Ward of the Neurosurgery Department, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Xian Luo
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- The First Ward of the Neurosurgery Department, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Jun Wang
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- The First Ward of the Neurosurgery Department, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Lili Yuan
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- The First Ward of the Neurosurgery Department, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Shunjun Zhao
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- The First Ward of the Neurosurgery Department, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yi Feng
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Shiming Huang
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Shunwu Xiao
- The First Ward of the Neurosurgery Department, Affiliated Hospital of Zunyi Medical University, Zunyi, China
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8
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Ortiz-Dosal A, Rodríguez-Aranda MC, Ortiz-Dosal LC, Núñez-Leyva JM, Rivera-Pérez E, Cuellar Camacho JL, Ávila-Delgadillo JR, Kolosovas-Machuca ES. Quasi-spherical silver nanoparticles for human prolactin detection by surface-enhanced Raman spectroscopy. RSC Adv 2024; 14:6998-7005. [PMID: 38414989 PMCID: PMC10897535 DOI: 10.1039/d3ra06366f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/20/2024] [Indexed: 02/29/2024] Open
Abstract
Prolactin is a polypeptide hormone made of 199 amino acids; 50% of the amino acid chain forms helices, and the rest forms loops. This hormone is typically related to initiating and maintaining lactation, although it is also elevated in various pathological conditions. Serum prolactin levels of 2 to 18 ng ml-1 in men, up to 30 ng ml-1 in women, and 10 to 210 ng ml-1 in pregnant women are considered normal. Immunoassay techniques used for detection are susceptible to error in different clinical conditions. Surface-enhanced Raman spectroscopy (SERS) is a technique that allows for obtaining the protein spectrum in a simple, fast, and reproducible manner. Nonetheless, proper characterization of human prolactin's Raman/SERS spectrum at different concentrations has so far not been deeply discussed. This study aims to characterize the Raman spectrum of human prolactin at physiological concentrations using silver nanoparticles (AgNPs) as the SERS substrate. The Raman spectrum of prolactin at 20 ng ul-1 was acquired. Quasi-spherical AgNPs were obtained using chemical synthesis. For SERS characterization, decreasing dilutions of the protein were made by adding deionized water and then a 1 : 1 volume of the AgNPs colloid. For each mixture, the Raman spectrum was determined. The spectrum of prolactin by SERS was obtained with a concentration of up to 0.1 ng ml-1. It showed characteristic bands corresponding to the side chains of aromatic amino acids in the protein's primary structure and the alpha helices of the secondary structure of prolactin. In conclusion, using quasi-spherical silver nanoparticles as the SERS substrate, the Raman spectrum of human prolactin at physiological concentration was determined.
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Affiliation(s)
- Alejandra Ortiz-Dosal
- Cátedras CONAHCYT - Facultad de Ciencias Universidad Autónoma de San Luis Potosí 1570 Parque Chapultepec Ave 78295 San Luis Potosí Mexico
| | - M C Rodríguez-Aranda
- Coordinación para la Innovación y Aplicación de la Ciencia y la Tecnología, Universidad Autónoma de San Luis Potosí 550 Sierra Leona Ave 78210 San Luis Potosí Mexico
- Facultad de Ciencias, Universidad Autónoma de San Luis Potosí 1570 Parque Chapultepec Ave 78295 San Luis Potosí Mexico
| | - Luis Carlos Ortiz-Dosal
- Maestría en Ciencia e Ingeniería de los Materiales (MCIM-UAZ), Universidad Autónoma de Zacatecas 801 López Velarde St 9800 Zacatecas Mexico
| | - Juan Manuel Núñez-Leyva
- Posdoctorado, CONAHCYT Mexico
- Maestría en Ciencia e Ingeniería de los Materiales (MCIM-UAZ), Universidad Autónoma de Zacatecas 801 López Velarde St 9800 Zacatecas Mexico
| | - Emmanuel Rivera-Pérez
- Coordinación para la Innovación y Aplicación de la Ciencia y la Tecnología, Universidad Autónoma de San Luis Potosí 550 Sierra Leona Ave 78210 San Luis Potosí Mexico
- Facultad de Ciencias, Universidad Autónoma de San Luis Potosí 1570 Parque Chapultepec Ave 78295 San Luis Potosí Mexico
| | - José Luis Cuellar Camacho
- Facultad de Ciencias, Universidad Autónoma de San Luis Potosí 1570 Parque Chapultepec Ave 78295 San Luis Potosí Mexico
| | - Julián Rosendo Ávila-Delgadillo
- Doctorado Institucional en Ingeniería y Ciencia de Materiales (DICIM-UASLP), Universidad Autónoma de San Luis Potosí 550 Sierra Leona Ave 78210 San Luis Potosí Mexico
- Coordinación para la Innovación y Aplicación de la Ciencia y la Tecnología, Universidad Autónoma de San Luis Potosí 550 Sierra Leona Ave 78210 San Luis Potosí Mexico
| | - Eleazar Samuel Kolosovas-Machuca
- Coordinación para la Innovación y Aplicación de la Ciencia y la Tecnología, Universidad Autónoma de San Luis Potosí 550 Sierra Leona Ave 78210 San Luis Potosí Mexico
- Facultad de Ciencias, Universidad Autónoma de San Luis Potosí 1570 Parque Chapultepec Ave 78295 San Luis Potosí Mexico
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9
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Dzialach L, Sobolewska J, Zak Z, Respondek W, Witek P. Prolactin-secreting pituitary adenomas: male-specific differences in pathogenesis, clinical presentation and treatment. Front Endocrinol (Lausanne) 2024; 15:1338345. [PMID: 38370355 PMCID: PMC10870150 DOI: 10.3389/fendo.2024.1338345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/22/2024] [Indexed: 02/20/2024] Open
Abstract
Prolactinomas (PRLomas) constitute approximately half of all pituitary adenomas and approximately one-fifth of them are diagnosed in males. The clinical presentation of PRLomas results from direct prolactin (PRL) action, duration and severity of hyperprolactinemia, and tumor mass effect. Male PRLomas, compared to females, tend to be larger and more invasive, are associated with higher PRL concentration at diagnosis, present higher proliferative potential, are more frequently resistant to standard pharmacotherapy, and thus may require multimodal approach, including surgical resection, radiotherapy, and alternative medical agents. Therefore, the management of PRLomas in men is challenging in many cases. Additionally, hyperprolactinemia is associated with a significant negative impact on men's health, including sexual function and fertility potential, bone health, cardiovascular and metabolic complications, leading to decreased quality of life. In this review, we highlight the differences in pathogenesis, clinical presentation and treatment of PRLomas concerning the male sex.
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Affiliation(s)
- Lukasz Dzialach
- Department of Internal Medicine, Endocrinology and Diabetes, Medical University of Warsaw, Warsaw, Poland
| | - Joanna Sobolewska
- Department of Internal Medicine, Endocrinology and Diabetes, Medical University of Warsaw, Warsaw, Poland
| | - Zuzanna Zak
- Department of Internal Medicine, Endocrinology and Diabetes, Medical University of Warsaw, Warsaw, Poland
| | - Wioleta Respondek
- Department of Internal Medicine, Endocrinology and Diabetes, Mazovian Brodnowski Hospital, Warsaw, Poland
| | - Przemysław Witek
- Department of Internal Medicine, Endocrinology and Diabetes, Medical University of Warsaw, Warsaw, Poland
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Carneiro MS, de Mira TAA, Yela DA, Benetti-Pinto CL. Prolactinoma in postmenopausal women: a systematic review. Menopause 2024; 31:160-167. [PMID: 38194617 DOI: 10.1097/gme.0000000000002303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
IMPORTANCE Prolactinomas occurring during the reproductive period exhibit a characteristic behavior. There are, however, gaps in the literature regarding the behavior of these tumors after menopause. OBJECTIVE This study aimed to review and characterize the influence of menopause on prolactinoma behavior. EVIDENCE REVIEW A systematic review of observational prospective or retrospective studies and clinical trials on prolactinomas was conducted in two situations: tumors diagnosed in the reproductive period (before menopause), with follow-up in the postmenopausal period, or prolactinomas diagnosed in the postmenopausal period, without language or date restrictions. Data extracted from the articles included patient and tumor characteristics (prolactinoma type, previous treatment, symptoms, and serum prolactin [PRL] levels). FINDINGS This study included five studies comprising 180 participants. Prolactinomas diagnosed in women of reproductive age are treated with dopaminergic agonists (DAs), with indications of treatment withdrawal after menopause, exhibited stable tumor behavior and PRL levels. Considering the diagnosis during the postmenopausal period, macroprolactinomas were more prevalent and showed tumor shrinkage when DAs were used. Cabergoline, the most commonly used drug, lowers PRL levels and reduces symptoms associated with adenoma. CONCLUSIONS AND RELEVANCE Microadenomas diagnosed before menopause can be followed up without treatment. Prolactinomas diagnosed after menopause are typically macroadenomas. Cabergoline remains the treatment of choice in the presence of clinical or compressive symptoms. We recommend at least one annual follow-up for such patients.
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Affiliation(s)
- Marcela Souza Carneiro
- From the Department of Gynecology and Obstetrics, University of Campinas, Campinas, São Paulo, Brazil
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11
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Basile M, Valentini I, Attanasio R, Cozzi R, Persichetti A, Samperi I, Scoppola A, Auriemma RS, De Menis E, Esposito F, Ferrante E, Iatì G, Mazzatenta D, Poggi M, Rudà R, Tortora F, Cruciani F, Mitrova Z, Saulle R, Vecchi S, Cappabianca P, Paoletta A, Bozzao A, Caputo M, Doglietto F, Ferraù F, Lania AG, Laureti S, Lello S, Locatelli D, Maffei P, Minniti G, Peri A, Ruini C, Settanni F, Silvani A, Veronese N, Grimaldi F, Papini E, Cicchetti A. A pharmacoeconomic analysis from Italian guidelines for the management of prolactinomas. GLOBAL & REGIONAL HEALTH TECHNOLOGY ASSESSMENT 2024; 11:1-16. [PMID: 38230389 PMCID: PMC10788683 DOI: 10.33393/grhta.2024.2601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 11/22/2023] [Indexed: 01/18/2024] Open
Abstract
Background Prolactinoma, the most common pituitary adenoma, is usually treated with dopamine agonist (DA) therapy like cabergoline. Surgery is second-line therapy, and radiotherapy is used if surgical treatment fails or in relapsing macroprolactinoma. Objective This study aimed to provide economic evidence for the management of prolactinoma in Italy, using a cost-of-illness and cost-utility analysis that considered various treatment options, including cabergoline, bromocriptine, temozolomide, radiation therapy, and surgical strategies. Methods The researchers conducted a systematic literature review for each research question on scientific databases and surveyed a panel of experts for each therapeutic procedure's specific drivers that contributed to its total cost. Results The average cost of the first year of treatment was €2,558.91 and €3,287.40 for subjects with microprolactinoma and macroprolactinoma, respectively. Follow-up costs from the second to the fifth year after initial treatment were €798.13 and €1,084.59 per year in both groups. Cabergoline had an adequate cost-utility profile, with an incremental cost-effectiveness ratio (ICER) of €3,201.15 compared to bromocriptine, based on a willingness-to-pay of €40,000 per quality-adjusted life year (QALY) in the reference economy. Endoscopic surgery was more cost-effective than cabergoline, with an ICER of €44,846.64. Considering a willingness-to-pay of €40,000/QALY, the baseline findings show cabergoline to have high cost utility and endoscopic surgery just a tad above that. Conclusions Due to the favorable cost-utility profile and safety of surgical treatment, pituitary surgery should be considered more frequently as the initial therapeutic approach. This management choice could lead to better outcomes and an appropriate allocation of healthcare resources.
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Affiliation(s)
- Michele Basile
- High School of Economy and Management of Health Systems, Catholic University of Sacred Heart, Rome
| | - Ilaria Valentini
- High School of Economy and Management of Health Systems, Catholic University of Sacred Heart, Rome
| | | | - Renato Cozzi
- ASST Grande Ospedale Metropolitano Niguarda, Endocrinology Department, Milan
| | - Agnese Persichetti
- Ministry of Interior, Department of Firefighters, Public Rescue and Civil Defense, Rome
| | | | | | - Renata Simona Auriemma
- Department of Clinical Medicine and Surgery, Endocrinology Section, ‘Federico II’ University of Naples, Naples
| | - Ernesto De Menis
- Internal Medicine 2, Treviso Hospital, Treviso and Functional Department of Endocrinology and Metabolism, AULSS 2 Veneto
| | - Felice Esposito
- Neurosurgical Clinic, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II’ University of Naples, Naples
| | - Emanuele Ferrante
- Endocrinology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan
| | - Giuseppe Iatì
- Department of Radiation Oncology, University of Messina, Messina
| | - Diego Mazzatenta
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neurochirurgia Ipofisi - Pituitary Unit, Bologna
| | - Maurizio Poggi
- Endocrinology, Department of Clinical and Molecular Medicine, S. Andrea Hospital, Sapienza University of Rome, Rome
| | - Roberta Rudà
- Division of Neurology, Castelfranco Veneto and Treviso Hospital, Treviso Division of Neuro-Oncology, Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Turin
| | - Fabio Tortora
- Radiology Unit, Department of Advanced Biomedical Sciences, University “Federico II”, Naples
| | - Fabio Cruciani
- Department of Epidemiology, Lazio Region Health Service, Rome
| | - Zuzana Mitrova
- Department of Epidemiology, Lazio Region Health Service, Rome
| | - Rosella Saulle
- Department of Epidemiology, Lazio Region Health Service, Rome
| | - Simona Vecchi
- Department of Epidemiology, Lazio Region Health Service, Rome
| | - Paolo Cappabianca
- Neurosurgical Clinic, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II’ University of Naples, Naples
| | | | - Alessandro Bozzao
- Neuroradiology, S. Andrea Hospital, NESMOS Department (Neuroscience, Mental Health, Sensorial Organs), Sapienza University of Rome, Rome
| | - Marco Caputo
- Laboratorio Analisi Cliniche e Microbiologia, Synlab SRL, Calenzano (FI)
| | | | - Francesco Ferraù
- Department of Human Pathology of Adulthood and Childhood ‘G. Barresi’, University of Messina, Messina
| | - Andrea Gerardo Lania
- Department of Biomedical Sciences, Endocrinology Unit, Humanitas Clinical and Research Center IRCCS, Humanitas University, Rozzano (MI)
| | | | - Stefano Lello
- Department of Woman and Child Health and Public Health, Institute of Obstetrics and Gynecology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome
| | - Davide Locatelli
- Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi, Varese
| | - Pietro Maffei
- Department of Medicine (DIMED), 3rd Medical Clinic, Padua University, Padua
| | - Giuseppe Minniti
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena
| | - Alessandro Peri
- Pituitary Diseases and Sodium Alterations Unit, AOU Careggi, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence
| | - Chiara Ruini
- Department of Psychology, University of Bologna, Bologna
| | - Fabio Settanni
- Clinical Biochemistry Laboratory, City of Health and Science University Hospital, Turin
| | - Antonio Silvani
- Department of Neuro-Oncology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano
| | - Nadia Veronese
- ASST Grande Ospedale Metropolitano Niguarda, Endocrinology Department, Milan
| | | | - Enrico Papini
- Endocrinology, Ospedale Regina Apostolorum, Albano Laziale (RM) - Italy
| | - Americo Cicchetti
- High School of Economy and Management of Health Systems, Catholic University of Sacred Heart, Rome
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12
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Sosa-Eroza E, Espinosa-Cárdenas E. Long-term Discontinuation of Dopamine Agonist Treatment in Patients with Prolactinomas Revisited. Arch Med Res 2023; 54:102893. [PMID: 37806785 DOI: 10.1016/j.arcmed.2023.102893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/22/2023] [Accepted: 09/26/2023] [Indexed: 10/10/2023]
Abstract
The most common type of functioning pituitary adenomas is prolactinomas; unlike other types, they are treated medically with dopamine agonists (DA). This treatment aims to normalize PRL levels and decrease tumor size by 50% or more. These objectives are typically achieved by 90% of patients with microprolactinoma, two-thirds of those with macroprolactinomas, and about half of those with giant prolactinomas. Life-long pharmacological treatment implies costs, discomfort, and the possibility of side effects, therefore, it has been suggested that DA discontinuation could be attempted in some patients. Long-term remission seems more likely in who, after 2 years of therapy achieve clinical, biochemical, and imaging remission criteria: no evidence of hypogonadism, a normal PRL level (preferably <5 ng/mL), and a >50% of tumor size reduction. Long-term remission seems to be more likely if the patient has been treated with cabergoline (CBG) for a minimum of 2 years, the PRL levels have normalized, tumor size has decreased by at least 50%, and the DA dose can gradually be tapered down to 0.25-0.5 mg per week. After treatment withdrawal, about 65% of patients experience a recurrence of hyperprolactinemia within the first 12 months of DA discontinuation. Although in most patients in whom DA discontinuation has been attempted, the hyperprolactinemia will recur, not all of them will require re-initiation of treatment. A good clinical judgement is crucial to identify those patients who need life-long treatment.
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Affiliation(s)
- Ernesto Sosa-Eroza
- Endocrinology Department, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
| | - Etual Espinosa-Cárdenas
- Endocrinology Department, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
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13
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Aguilar-Riera C, Clemente M, González-Llorens N, Mogas E, Campos-Martorell A, Fàbregas A, Biagetti B, Vázquez E, Yeste D. Pituitary macroadenomas in childhood and adolescence: a clinical analysis of 7 patients. Clin Diabetes Endocrinol 2023; 9:5. [PMID: 37908013 PMCID: PMC10619272 DOI: 10.1186/s40842-023-00153-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 10/18/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Pituitary adenomas (PPAs) are uncommon in childhood and adolescence, accounting for 2-6% of all intracranial neoplasms. Delayed puberty, growth retardation, galactorrhea and weight gain are common features at presentation in pediatric patients. Functional tumors constitute a vast majority (90%) of PPAs, with the most frequent being prolactinomas. CASE PRESENTATION A retrospective review of the clinical features and outcomes of 7 pediatric patients with pituitary macroadenomas was conducted. We included PPAs in patients under 18 years at diagnosis with diameters larger than 10 mm by magnetic resonance (MRI). Six patients were males (85%), with age at diagnosis ranging from 8 to 15 (median 14 ± 2.8SDS). The primary symptoms that led to medical attention were growth retardation, gigantism and secondary amenorrhea. The visual field was reduced in three cases (42%). Suprasellar extension was present in 3 subjects, and one had a giant adenoma. Adenomas were clinically functioning in 6 patients (85%) (three prolactinomas, two somatropinomas, one secreting FSH and one no-producer). The prolactinomas responded to treatment with cabergoline. For the rest, one required transsphenoidal surgery and the other three both surgery and radiotherapy. All patients undergoing radiotherapy had secondary panhypopituitarism. In relation to the genetic studies, two patients presented a pathogenic mutation of the AIP gene and one of the MEN1. DISCUSION AND CONCLUSION Pediatric pituitary macroadenomas are a distinct entity, mostly found in males and with a predominance of functional tumors leading to detrimental effects on growth and puberty in addition to neuro-ophthalmological manifestations. It is important to perform genetic studies in patients with macroadenomas appearing under the age of 18 years as genetic and syndromic associations are more frequent in this age group.
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Affiliation(s)
| | - María Clemente
- Pediatric Endocrinology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- CIBER Enfermedades Raras, Instituto Carlos III, Madrid, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Eduard Mogas
- Pediatric Endocrinology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Ariadna Campos-Martorell
- Pediatric Endocrinology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anna Fàbregas
- Pediatric Endocrinology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Betina Biagetti
- Endocrinology and Nutrition Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Elida Vázquez
- Pediatric Radiology Service, Hospital Universitari, Vall d'Hebron, Barcelona, Spain
| | - Diego Yeste
- Pediatric Endocrinology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- CIBER Enfermedades Raras, Instituto Carlos III, Madrid, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
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14
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Auriemma RS, Pirchio R, Pivonello C, Garifalos F, Colao A, Pivonello R. Approach to the Patient With Prolactinoma. J Clin Endocrinol Metab 2023; 108:2400-2423. [PMID: 36974474 PMCID: PMC10438891 DOI: 10.1210/clinem/dgad174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 03/03/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023]
Abstract
Prolactinomas are the most common pituitary tumor histotype, with microprolactinomas being prevalent in women and macroprolactinomas in men. Hyperprolactinemia is among the most common causes of hypogonadotropic hypogonadism in both sexes, prompting medical advice for hypogonadism (infertility, oligo-amenorrhea, impotence, osteoporosis/osteopenia) in both sexes, and for signs and symptoms of mass effects (hypopituitarism, visual loss, optic chiasm compression, cranial nerve deficits, headaches) predominantly in men. Diagnostic workup involves a single prolactin measurement and pituitary imaging, but some laboratory artifacts (ie, the "hook effect" and macroprolactin) can complicate or delay the diagnosis. The treatment of choice for prolactinomas is represented by dopamine agonists, mainly cabergoline, which are able to induce disease control, restore fertility in both sexes, and definitively cure one-third of patients, thus permitting treatment discontinuation. Pregnancy and menopause may promote spontaneous prolactin decline and anticipate cabergoline discontinuation in women. Surgery and/or radiotherapy are indicated in case of resistance to cabergoline not overcome by the increase in drug dose up to the maximally tolerated or the patient's personal choice of surgery. The evidence of resistance to cabergoline in invasive and proliferative tumors may indicate biological aggressiveness, thus requiring alternative therapeutic approaches mainly based on temozolomide use as monotherapy or combined with radiotherapy. In uncontrolled patients, new medical approaches (alternative hormonal treatments, cytotoxic drugs, peptide receptor radionuclide therapy, mTOR/Akt inhibitors, tyrosine kinase inhibitors, or immunotherapy) may be offered but the experience collected to date is still very scant. This article reviews different facets of prolactinomas and discusses approaches to the condition in more common clinical situations.
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Affiliation(s)
- Renata S Auriemma
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, 80131 Naples, Italy
| | - Rosa Pirchio
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, 80131 Naples, Italy
| | - Claudia Pivonello
- Dipartimento di Sanità Pubblica, Università Federico II di Napoli, 80131 Naples, Italy
| | - Francesco Garifalos
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, 80131 Naples, Italy
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Unità di Andrologia e Medicina della Riproduzione e Sessualità Maschile e Femminile (FERTISEXCARES), Università Federico II di Napoli, 80131 Naples, Italy
| | - Annamaria Colao
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, 80131 Naples, Italy
- Unesco Chair for Health Education and Sustainable Development, “Federico II” University, 80131 Naples, Italy
| | - Rosario Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, 80131 Naples, Italy
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Unità di Andrologia e Medicina della Riproduzione e Sessualità Maschile e Femminile (FERTISEXCARES), Università Federico II di Napoli, 80131 Naples, Italy
- Unesco Chair for Health Education and Sustainable Development, “Federico II” University, 80131 Naples, Italy
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15
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Menon LP, Edem D. A case of giant prolactinoma and pituitary hemorrhage with the late recovery of pituitary function: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231190672. [PMID: 37533485 PMCID: PMC10392158 DOI: 10.1177/2050313x231190672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 07/12/2023] [Indexed: 08/04/2023] Open
Abstract
Hypogonadotropic hypogonadism is a common finding in patients who are diagnosed with a prolactinoma. It can be accompanied by the presence of other pituitary hormone deficits, including secondary adrenal insufficiency and central hypothyroidism. While the proportion of improvement in endocrine deficits over the short term is well characterized, there is not enough literature about the recovery of pituitary function over the longer term. We present the case of a 23-year-old man with a giant prolactinoma who initially presented with pituitary hemorrhage and panhypopituitarism. He underwent decompression of the pituitary tumor followed by treatment with cabergoline. Over a 9-year follow-up period, we noted that the hypogonadotropic hypogonadism resolved after 4 years and the secondary adrenal insufficiency resolved after 8 years. This case suggests that partial or complete recovery of the pituitary function is possible over the long-term even in patients with a giant prolactinoma.
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Affiliation(s)
- Lakshmi P Menon
- Lakshmi P Menon, Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St., slot #587, Little Rock, AR 72205-7199, USA.
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16
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Corona G, Cucinotta D, Di Lorenzo G, Ferlin A, Giagulli VA, Gnessi L, Isidori AM, Maiorino MI, Miserendino P, Murrone A, Pivonello R, Rochira V, Sangiorgi GM, Stagno G, Foresta C, Lenzi A, Maggi M, Jannini EA. The Italian Society of Andrology and Sexual Medicine (SIAMS), along with ten other Italian Scientific Societies, guidelines on the diagnosis and management of erectile dysfunction. J Endocrinol Invest 2023; 46:1241-1274. [PMID: 36698034 PMCID: PMC9876440 DOI: 10.1007/s40618-023-02015-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 01/16/2023] [Indexed: 01/27/2023]
Abstract
PURPOSE Erectile dysfunction (ED) is one of the most prevalent male sexual dysfunctions. ED has been in the past mistakenly considered a purely psycho-sexological symptom by patients and doctors. However, an ever-growing body of evidence supporting the role of several organic factors in the pathophysiological mechanisms underlying ED has been recognized. METHODS The Italian Society of Andrology and Sexual Medicine (SIAMS) commissioned an expert task force involving several other National Societies to provide an updated guideline on the diagnosis and management of ED. Derived recommendations were based on the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. RESULTS Several evidence-based statements were released providing the necessary up-to-date guidance in the context of ED with organic and psychosexual comorbidities. Many of them were related to incorrect lifestyle habits suggesting how to associate pharmacotherapies and counseling, in a couple-centered approach. Having the oral therapy with phosphodiesterase type 5 inhibitors as the gold standard along with several other medical and surgical therapies, new therapeutic or controversial options were also discussed. CONCLUSIONS These are the first guidelines based on a multidisciplinary approach that involves the most important Societies related to the field of sexual medicine. This fruitful discussion allowed for a general agreement on several recommendations and suggestions to be reached, which can support all stakeholders in improving couple sexual satisfaction and overall general health.
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Affiliation(s)
- G Corona
- Endocrinology Unit, Medical Department, Maggiore-Bellaria Hospital, Azienda Usl, Bologna, Italy
| | - D Cucinotta
- Chair of Internal Medicine, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - G Di Lorenzo
- Section of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- IRCCS Fondazione Santa Lucia, Rome, Italy
| | - A Ferlin
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, Padua, Italy
| | - V A Giagulli
- Interdisciplinary Department of Medicine-Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari "Aldo Moro", Bari, Italy
- Santa Maria Hospital, GVM Care & Research, Bari, Italy
| | - L Gnessi
- Section of Food Science, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - A M Isidori
- Section of Endocrinology, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - M I Maiorino
- Division of Endocrinology and Metabolic Diseases, Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - P Miserendino
- Diabetology and Endocrinology Unit, ASP #, Caltanissetta, Italy
| | - A Murrone
- Cardiology Unit, Città di Castello and Gubbio-GualdoTadino Hospitals, Azienda Usl Umbria 1, Gubbio, Italy
| | - R Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Unità di Andrologia e Medicina della Riproduzione e della Sessualità Maschile e Femminile, Università Federico II di Napoli, Naples, Italy
- Staff of UNESCO Chair for Health Education and Sustainable Development, Federico II University, Naples, Italy
| | - V Rochira
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - G M Sangiorgi
- Department of Biomedicine and Prevention, Policlinico Tor Vergata, Rome, Italy
| | - G Stagno
- Diabetology Unit, ASP Reggio Calabria, Reggio Calabria, Italy
| | - C Foresta
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, Padua, Italy
| | - A Lenzi
- Section of Food Science, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - M Maggi
- Endocrinology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | - E A Jannini
- Chair of Endocrinology and Sexual Medicine (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, E Tower South Floor 4, Room E413, Via Montpellier 1, 00133, Rome, Italy.
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Cozzi R, Auriemma RS, De Menis E, Esposito F, Ferrante E, Iatì G, Mazzatenta D, Poggi M, Rudà R, Tortora F, Cruciani F, Mitrova Z, Saulle R, Vecchi S, Basile M, Cappabianca P, Paoletta A, Papini E, Persichetti A, Samperi I, Scoppola A, Bozzao A, Caputo M, Doglietto F, Ferraù F, Lania AG, Laureti S, Lello S, Locatelli D, Maffei P, Minniti G, Peri A, Ruini C, Settanni F, Silvani A, Veronese N, Grimaldi F, Attanasio R. Italian Guidelines for the Management of Prolactinomas. Endocr Metab Immune Disord Drug Targets 2023; 23:1459-1479. [PMID: 37171003 PMCID: PMC10556400 DOI: 10.2174/1871530323666230511104045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/04/2023] [Accepted: 05/04/2023] [Indexed: 05/13/2023]
Abstract
INTRODUCTION This guideline (GL) is aimed at providing a reference for the management of prolactin (PRL)-secreting pituitary adenoma in adults. However, pregnancy is not considered. METHODS This GL has been developed following the methods described in the Manual of the Italian National Guideline System. For each question, the panel appointed by Associazione Medici Endocrinologi (AME) has identified potentially relevant outcomes, which have then been rated for their impact on therapeutic choices. Only outcomes classified as "critical" and "important" have been considered in the systematic review of evidence and only those classified as "critical" have been considered in the formulation of recommendations. RESULTS The present GL provides recommendations regarding the role of pharmacological and neurosurgical treatment in the management of prolactinomas. We recommend cabergoline (Cab) vs. bromocriptine (Br) as the firstchoice pharmacological treatment to be employed at the minimal effective dose capable of achieving the regression of the clinical picture. We suggest that medication and surgery are offered as suitable alternative first-line treatments to patients with non-invasive PRL-secreting adenoma, regardless of size. We suggest Br as an alternative drug in patients who are intolerant to Cab and are not candidates for surgery. We recommend pituitary tumor resection in patients 1) without any significant neuro-ophthalmologic improvement within two weeks from the start of Cab, 2) who are resistant or do not tolerate Cab or other dopamine-agonist drugs (DA), 3) who escape from previous efficacy of DA, and 4) who are unwilling to undergo a chronic DA treatment. We recommend that patients with progressive disease notwithstanding previous tumor resection and ongoing DA should be managed by a multidisciplinary team with specific expertise in pituitary diseases using a multimodal approach that includes repeated surgery, radiotherapy, DA, and possibly, the use of temozolomide. CONCLUSION The present GL is directed to endocrinologists, neurosurgeons, and gynecologists working in hospitals, in territorial services or private practice, and to general practitioners and patients.
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Affiliation(s)
- Renato Cozzi
- Department of Endocrinology ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Renata Simona Auriemma
- Department of Molecular and Clinical Endocrinology and Oncology, Federico II University of Naples, Italy
| | - Ernesto De Menis
- Internal Medicine 2, Treviso Hospital, Treviso; Functional Department of Endocrinology and Metabolism, AULSS 2 Veneto, Italy
| | - Felice Esposito
- Neurosurgical Clinic, Department of Neurosciences and Reproductive and Odontostomatological Sciences, “Federico II” University of Naples, Italy
| | - Emanuele Ferrante
- Endocrinology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giuseppe Iatì
- Department of Radiation Oncology, University of Messina, Italy
| | - Diego Mazzatenta
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neurochirurgia Ipofisi - Pituitary Unit, Bologna, Italy
| | - Maurizio Poggi
- Endocrinology, Department of Clinical and Molecular Medicine, S. Andrea Hospital, Sapienza University of Rome, Italy
| | - Roberta Rudà
- Division of Neurology, Castelfranco Veneto and Treviso Hospital, Treviso; Division of Neuro-Oncology, Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Italy
| | - Fabio Tortora
- Radiology Unit, Department of Advanced Biomedical Sciences, University “Federico II”, Naples, Italy
| | - Fabio Cruciani
- Department of Epidemiology, Lazio Region Health Service, Rome, Italy
| | - Zuzana Mitrova
- Department of Epidemiology, Lazio Region Health Service, Rome, Italy
| | - Rosella Saulle
- Department of Epidemiology, Lazio Region Health Service, Rome, Italy
| | - Simona Vecchi
- Department of Epidemiology, Lazio Region Health Service, Rome, Italy
| | - Michele Basile
- High School of Economy and Management of Health Systems, Catholic University of Sacred Heart, Rome, Italy
| | - Paolo Cappabianca
- Neurosurgical Clinic, Department of Neurosciences and Reproductive and Odontostomatological Sciences, “Federico II” University of Naples, Italy
| | | | - Enrico Papini
- Endocrinology, Ospedale Regina Apostolorum, Albano Laziale
| | - Agnese Persichetti
- Ministry of Interior - Department of Firefighters, Public Rescue and Civil Defense, Rome, Italy
| | | | | | - Alessandro Bozzao
- Neuroradiology, S. Andrea Hospital, NESMOS Department (Neuroscience, Mental Health, Sensorial Organs), Sapienza University of Rome, Italy
| | - Marco Caputo
- Laboratorio Analisi Cliniche e Microbiologia, Synlab SRL, Calenzano (FI), Italy
| | - Francesco Doglietto
- Institute of Neurosurgery, Catholic University School of Medicine, Rome, Italy
| | - Francesco Ferraù
- Department of Human Pathology of Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy
| | - Andrea Gerardo Lania
- Department of Biomedical Sciences, Endocrinology Unit, Humanitas Clinical and Research Center IRCCS, Humanitas University, Rozzano (MI), Italy
| | | | - Stefano Lello
- Department of Woman and Child Health and Public Health, Institute of Obstetrics and Gynecology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Davide Locatelli
- Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi, Varese, Italy
| | - Pietro Maffei
- Department of Medicine (DIMED), 3 Medical Clinic, Padua University, Italy
| | - Giuseppe Minniti
- Radiation Oncology Unit, Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Alessandro Peri
- Pituitary Diseases and Sodium Alterations Unit, Endocrinology, AOU Careggi, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Italy
| | - Chiara Ruini
- Department of Psychology, University of Bologna, Italy
| | - Fabio Settanni
- Clinical Biochemistry Laboratory, City of Health and Science University Hospital, Turin, Italy
| | - Antonio Silvani
- Department of Neuro-Oncology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Nadia Veronese
- Department of Endocrinology ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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Corona G, Rastrelli G, Comeglio P, Guaraldi F, Mazzatenta D, Sforza A, Vignozzi L, Maggi M. The metabolic role of prolactin: systematic review, meta-analysis and preclinical considerations. Expert Rev Endocrinol Metab 2022; 17:533-545. [PMID: 36447418 DOI: 10.1080/17446651.2022.2144829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 11/03/2022] [Indexed: 12/03/2022]
Abstract
INTRODUCTION Hyperprolactinemia has been proven to induce hypogonadism and metabolic derangements in both genders, while the consequences of prolactin (PRL) deficiency have been poorly investigated. AREAS COVERED To systematically review and analyze data from clinical studies focusing on the metabolic consequences of abnormally high prolactin levels (HPRL) and low prolactin levels (LPRL). In addition, data from preclinical studies about underlying pathophysiological mechanisms were summarized and discussed. EXPERT OPINION PRL contributes to providing the correct amount of energy to support the mother and the fetus/offspring during pregnancy and lactation, but it also has a homeostatic role. Pathological PRL elevation beyond these physiological conditions, but also its reduction, impairs metabolism and body composition in both genders, increasing the risk of diabetes and cardiovascular events. Hence, hypoprolactinemia should be avoided as much as possible during treatment with dopamine agonists for prolactinomas. Patients with hypoprolactinemia, because of endogenous or iatrogenic conditions, deserve, as those with hyperprolactinemia, careful metabolic assessment.
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Affiliation(s)
- Giovanni Corona
- Endocrinology Unit1, Medical Department, Azienda Usl, Maggiore-Bellaria Hospital, Bologna, Italy
| | - Giulia Rastrelli
- Andrology, Women's Endocrinology and Gender Incongruence Unit2, Mario Serio Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Paolo Comeglio
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Mario Serio Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Federica Guaraldi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Diego Mazzatenta
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Alessandra Sforza
- Endocrinology Unit1, Medical Department, Azienda Usl, Maggiore-Bellaria Hospital, Bologna, Italy
| | - Linda Vignozzi
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Mario Serio Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Mario Maggi
- Department of Biomedical and Neuromotor Sciences (DIBINEM)4, Alma Mater Studiorum Bologna University, Bologna, Italy; Endocrinology Unit 4, Mario Serio Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
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Inder WJ, Jang C. Treatment of Prolactinoma. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58081095. [PMID: 36013562 PMCID: PMC9413135 DOI: 10.3390/medicina58081095] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 08/09/2022] [Indexed: 05/14/2023]
Abstract
Prolactinomas are the commonest form of pituitary neuroendocrine tumor (PitNET), representing approximately half of such tumors. Dopamine agonists (DAs) have traditionally been the primary treatment for the majority of prolactinomas, with surgery considered the second line. The aim of this review is to examine the historical and modern management of prolactinomas, including medical therapy with DAs, transsphenoidal surgery, and multimodality therapy for the treatment of aggressive prolactinomas and metastatic PitNETs, with an emphasis on the efficacy, safety, and future directions of current therapeutic modalities. DAs have been the mainstay of prolactinoma management since the 1970s, initially with bromocriptine and more recently with cabergoline. Cabergoline normalizes prolactin in up to 85% of patients and causes tumor shrinkage in up to 80%. Primary surgical resection of microprolactinomas and enclosed macroprolactinomas performed by experienced pituitary neurosurgeons have similar remission rates to cabergoline. Aggressive prolactinomas and metastatic PitNETS should receive multimodality therapy including high dose cabergoline, surgery, radiation therapy (preferably using stereotactic radiosurgery where suitable), and temozolomide. DAs remain a reliable mode of therapy for most prolactinomas but results from transsphenoidal surgery in expert hands have improved considerably over the last one to two decades. Surgery should be strongly considered as primary therapy, particularly in the setting of microprolactinomas, non-invasive macroprolactinomas, or prior to attempting pregnancy, and has an important role in the management of DA resistant and aggressive prolactinomas.
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Affiliation(s)
- Warrick J. Inder
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Woolloongabba 4102, Australia
- Academy for Medical Education, Faculty of Medicine, The University of Queensland, Herston 4029, Australia
- Correspondence: ; Tel.: +61-7-3176-9563
| | - Christina Jang
- Department of Endocrinology and Diabetes, Royal Brisbane and Women’s Hospital, Herston 4029, Australia
- Faculty of Medicine, The University of Queensland, Herston 4029, Australia
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Bashari WA, van der Meulen M, MacFarlane J, Gillett D, Senanayake R, Serban L, Powlson AS, Brooke AM, Scoffings DJ, Jones J, O'Donovan DG, Tysome J, Santarius T, Donnelly N, Boros I, Aigbirhio F, Jefferies S, Cheow HK, Mendichovszky IA, Kolias AG, Mannion R, Koulouri O, Gurnell M. 11C-methionine PET aids localization of microprolactinomas in patients with intolerance or resistance to dopamine agonist therapy. Pituitary 2022; 25:573-586. [PMID: 35608811 PMCID: PMC9345820 DOI: 10.1007/s11102-022-01229-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/03/2022] [Indexed: 10/29/2022]
Abstract
PURPOSE To assess the potential for 11C-methionine PET (Met-PET) coregistered with volumetric magnetic resonance imaging (Met-PET/MRCR) to inform clinical decision making in patients with poorly visualized or occult microprolactinomas and dopamine agonist intolerance or resistance. PATIENTS AND METHODS Thirteen patients with pituitary microprolactinomas, and who were intolerant (n = 11) or resistant (n = 2) to dopamine agonist therapy, were referred to our specialist pituitary centre for Met-PET/MRCR between 2016 and 2020. All patients had persistent hyperprolactinemia and were being considered for surgical intervention, but standard clinical MRI had shown either no visible adenoma or equivocal appearances. RESULTS In all 13 patients Met-PET/MRCR demonstrated a single focus of avid tracer uptake. This was localized either to the right or left side of the sella in 12 subjects. In one patient, who had previously undergone surgery for a left-sided adenoma, recurrent tumor was unexpectedly identified in the left cavernous sinus. Five patients underwent endoscopic transsphenoidal selective adenomectomy, with subsequent complete remission of hyperprolactinaemia and normalization of other pituitary function; three patients are awaiting surgery. In the patient with inoperable cavernous sinus disease PET-guided stereotactic radiosurgery (SRS) was performed with subsequent near-normalization of serum prolactin. Two patients elected for a further trial of medical therapy, while two declined surgery or radiotherapy and chose to remain off medical treatment. CONCLUSIONS In patients with dopamine agonist intolerance or resistance, and indeterminate pituitary MRI, molecular (functional) imaging with Met-PET/MRCR can allow precise localization of a microprolactinoma to facilitate selective surgical adenomectomy or SRS.
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Affiliation(s)
- W A Bashari
- Cambridge Endocrine Molecular Imaging Group, Metabolic Research Laboratories, Wellcome-MRC Institute of Metabolic Science, University of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
| | - M van der Meulen
- Cambridge Endocrine Molecular Imaging Group, Metabolic Research Laboratories, Wellcome-MRC Institute of Metabolic Science, University of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
| | - J MacFarlane
- Cambridge Endocrine Molecular Imaging Group, Metabolic Research Laboratories, Wellcome-MRC Institute of Metabolic Science, University of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
| | - D Gillett
- Cambridge Endocrine Molecular Imaging Group, Metabolic Research Laboratories, Wellcome-MRC Institute of Metabolic Science, University of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
- Department of Nuclear Medicine, University of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
| | - R Senanayake
- Cambridge Endocrine Molecular Imaging Group, Metabolic Research Laboratories, Wellcome-MRC Institute of Metabolic Science, University of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
| | - L Serban
- Cambridge Endocrine Molecular Imaging Group, Metabolic Research Laboratories, Wellcome-MRC Institute of Metabolic Science, University of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
| | - A S Powlson
- Cambridge Endocrine Molecular Imaging Group, Metabolic Research Laboratories, Wellcome-MRC Institute of Metabolic Science, University of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
| | - A M Brooke
- Macleod Diabetes and Endocrine Centre, Royal Devon and Exeter Hospital, Exeter, UK
| | - D J Scoffings
- Department of Radiology, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
| | - J Jones
- Department of Radiology, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
| | - D G O'Donovan
- Department of Neuropathology, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
| | - J Tysome
- Department of Otolaryngology, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
| | - T Santarius
- Department of Neurosurgery, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
| | - N Donnelly
- Department of Otolaryngology, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
| | - I Boros
- Wolfson Brain Imaging Centre, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
| | - F Aigbirhio
- Wolfson Brain Imaging Centre, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
| | - S Jefferies
- Department of Oncology, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
| | - H K Cheow
- Cambridge Endocrine Molecular Imaging Group, Metabolic Research Laboratories, Wellcome-MRC Institute of Metabolic Science, University of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
- Department of Nuclear Medicine, University of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
- Department of Radiology, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
| | - I A Mendichovszky
- Cambridge Endocrine Molecular Imaging Group, Metabolic Research Laboratories, Wellcome-MRC Institute of Metabolic Science, University of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
- Department of Nuclear Medicine, University of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
- Department of Radiology, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
| | - A G Kolias
- Department of Neurosurgery, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
| | - R Mannion
- Department of Neurosurgery, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
| | - O Koulouri
- Cambridge Endocrine Molecular Imaging Group, Metabolic Research Laboratories, Wellcome-MRC Institute of Metabolic Science, University of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
| | - M Gurnell
- Cambridge Endocrine Molecular Imaging Group, Metabolic Research Laboratories, Wellcome-MRC Institute of Metabolic Science, University of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK.
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Bakker LEH, Verstegen MJT, Ghariq E, Verbist BM, Schutte PJ, Bashari WA, Kruit MC, Pereira AM, Gurnell M, Biermasz NR, van Furth WR, Bouda LMPA. Implementation of functional imaging using 11C-methionine PET-CT co-registered with MRI for advanced surgical planning and decision making in prolactinoma surgery. Pituitary 2022; 25:587-601. [PMID: 35616762 PMCID: PMC9345807 DOI: 10.1007/s11102-022-01230-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/06/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE To report the first experience of our multidisciplinary team with functional imaging using 11C-methionine positron emission tomography-computed tomography (11C-methionine PET-CT) co-registered with MRI (Met-PET/MRICR) in clinical decision making and surgical planning of patients with difficult to treat prolactinoma. METHODS In eighteen patients with prolactinoma, referred to our tertiary referral centre because of intolerance or resistance for dopamine agonists (DA), Met-PET/MRICR was used to aid decision-making regarding therapy. RESULTS Met-PET/MRICR was positive in 94% of the patients. MRI and Met-PET/MRICR findings were completely concordant in five patients, partially concordant in nine patients, and non-concordant in four patients. In five patients Met-PET/MRICR identified lesion(s) that were retrospectively also visible on MRI. Met-PET/MRICR was false negative in one patient, with a cystic adenoma on conventional MRI. Thirteen patients underwent transsphenoidal surgery, with nine achieving full biochemical remission, two clinical improvement and near normalized prolactin levels, and one patient clinical improvement with significant tumour reduction. Hence, nearly all patients (94%) were considered to have a positive outcome. Permanent complication rate was low. Three patients continued DA, two patients have a wait and scan policy. CONCLUSION Met-PET/MRICR can provide additional information to guide multidisciplinary preoperative and intraoperative decision making in selected cases of prolactinoma. This approach resulted in a high remission rate with a low rate of complications in our expert centre.
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Affiliation(s)
- Leontine E H Bakker
- Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands.
- Center for Endocrine Tumors Leiden (CETL), Pituitary Center, Leiden University Medical Center, Leiden, The Netherlands.
| | - Marco J T Verstegen
- Center for Endocrine Tumors Leiden (CETL), Pituitary Center, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Eidrees Ghariq
- Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Berit M Verbist
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Pieter J Schutte
- Center for Endocrine Tumors Leiden (CETL), Pituitary Center, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Waiel A Bashari
- Wellcome-MRC Institute of Metabolic Science, Addenbrooke's Hospital, University of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Mark C Kruit
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Alberto M Pereira
- Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands
- Center for Endocrine Tumors Leiden (CETL), Pituitary Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Mark Gurnell
- Wellcome-MRC Institute of Metabolic Science, Addenbrooke's Hospital, University of Cambridge and National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Nienke R Biermasz
- Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands
- Center for Endocrine Tumors Leiden (CETL), Pituitary Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Wouter R van Furth
- Center for Endocrine Tumors Leiden (CETL), Pituitary Center, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Lenka M Pereira Arias Bouda
- Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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