Endocrine Abstracts

Prolactinomas are the most common pituitary tumours with a prevalence varying from 0.3 to 0.5/1000 in the general population. This tumor has a large female predominance and a median age at diagnosis of 30 years. Prolactinomas in men are characterized by a larger size and a higher frequency of compressive symptoms, invasiveness, and resistance to therapy. Although the diagnosis of prolactinoma is often straightforward and the treatment strategy has been well defined in recent guidelines, new information has been provided over the past few years that may change the current management of these pituitary tumours. Moreover, several challenging issues in diagnosis and treatment still persist. As an example, the diagnosis of microprolactinoma is not always sufficiently well substantiated and this may lead to inappropriate prolonged treatment with a dopamine agonist. Also, the differential diagnosis of a large pituitary tumour with moderately elevated PRL concentrations remains sometimes difficult. The treatment of resistant and/or aggressive prolactinomas remains a challenge for the clinician, especially in young patients. Potential cardiac valve side-effects of long-term treatment with high doses of dopamine agonists should also be taken into account in the treatment strategy of such tumours. Management of prolactinoma in a young woman wishing to become pregnant, conditions of dopamine agonist withdrawal, or the place of transsphenoidal surgery are also still matters of debate. In this Meet-the-Expert session, illustrative clinical cases will be presented and diagnostic and therapeutic issues will be the subject of interactive discussion.