Endocrine Abstracts

This review was published in Nature Reviews Endocrinology. It covers recent advances in treatment of pituitary tumours secreting prolactin including long-term adverse effects of dopamine agonist therapy, outcomes following dopamine agonists withdrawal, advances in surgical tumour resection. In addition, there are sections on management during pregnancy, effects of hyperprolactinemia on bone and fracture risk, the management of cystic and aggressive prolactinomas. Prolactinomas in children and transgender patients are also covered. With regard to valvulopathy and cabergoline, screening of patients under a dose of 2mg is likely unnecessary. With patients on more than 2mg cardiac echo is recommended every 2-3 years. Dopamine agonist withdrawal is important and looking for factors which predict successful remission on withdrawal include low maintenance dose of cabergoline treatment, duration of > 2 years and substantial adenoma size reduction. Surgery in an experienced neurosurgical hand, can achieve initial normoprolactinemia in up to 93% individuals with microprolactinoma and 75% of those with selected macroprolactinomas. There’s an argument in some patients for suggesting surgical treatment. Particularly in those with intolerance of dopamine agonists and resistance to dopamine agonists. The presence of a cystic component is not uncommon in all pituitary adenomas. Dopamine agonist therapy can demonstrate a high efficacy in cyst reduction. Giant prolactinomas are rare and observed mainly in men. They usually respond well to dopamine agonist therapy. Surgical treatment is restricted to those with apoplexy or CSF leakage. Male sex of a young age and invasiveness are associated with an increased risk of dopamine agonist resistance. During pregnancy cabergoline is now preferred by the majority of centres. Dopamine agonist withdrawal should be considered postmenopausally. In patients with psychiatric disorders, management requires careful collaboration between psychiatry and endocrinology. Assimilation of these guidelines is important. They cover all important aspects of the modern management of prolactin secreting tumours.