Prolaktynoma – Zapobieganie i profilaktyka

Prolaktynoma
Zapobieganie i profilaktyka

Prolaktynoma to łagodny gruczolak przysadki wydzielający prolaktynę, prowadzący do hiperprolaktynemii i związanych z nią objawów, takich jak zaburzenia cyklu miesiączkowego u kobiet czy hipogonadyzm u mężczyzn. Nie istnieją skuteczne metody pierwotnej prewencji, gdyż etiologia jest w większości przypadków nieznana, z wyjątkiem dziedzicznego zespołu MEN1. Diagnostyka opiera się na oznaczeniu stężenia prolaktyny oraz obrazowaniu przysadki, a leczenie farmakologiczne agonistami dopaminy (np. kabergoliną, bromokryptyną) jest terapią z wyboru, skutecznie normalizującą poziom prolaktyny i zmniejszającą rozmiar guza. W przypadku makroprolaktynoma (>10 mm) konieczne jest ścisłe monitorowanie, zwłaszcza w okresie ciąży, ze względu na ryzyko powiększenia guza i powikłań neurologicznych. Ryzyko walopatii związanej z kabergoliną (CAV) wymaga ograniczenia ekspozycji na lek i rozważenia alternatywnych metod leczenia, takich jak operacja czy radioterapia.

Prolaktynoma – profilaktyka i zapobieganie

Czynniki ryzyka i genetyczne uwarunkowania
Wczesna diagnostyka jako element profilaktyki
Zmniejszenie ryzyka walopatii związanej z leczeniem kabergoliną

Postępowanie w ciąży u pacjentek z prolaktynoma

Poradnictwo przed ciążą
Postępowanie w zależności od rozmiaru guza
Monitorowanie i postępowanie podczas ciąży
Postępowanie po porodzie i karmienie piersią

Profilaktyka nawrotów i monitorowanie powikłań

Opcje leczenia w zapobieganiu nawrotom
Strategie minimalizacji ekspozycji na leki
Kolejne rozdziały

Prolaktynoma – profilaktyka i zapobieganie

Prolaktynoma jest łagodnym guzem przysadki wydzielającym prolaktynę, który może prowadzić do szeregu objawów związanych z nadmiernym poziomem tego hormonu w organizmie. Niestety, nie istnieją skuteczne metody zapobiegania rozwojowi prolaktynoma, ponieważ nie zidentyfikowano w pełni przyczyn powstawania tego typu guzów¹²³. Większość przypadków prolaktynoma rozwija się bez znanej przyczyny, co ogranicza możliwości prewencji pierwotnej⁴.

Czynniki ryzyka i genetyczne uwarunkowania

Jedynym znanym czynnikiem ryzyka rozwoju prolaktynoma jest dziedziczna (przekazywana przez rodzinę biologiczną) choroba zwana zespołem mnogiej gruczolakowatości wewnątrzwydzielniczej typu 1 (MEN1). W przypadku występowania tej choroby u krewnych pierwszego stopnia (biologiczne rodzeństwo lub rodzic), warto rozważyć poradnictwo genetyczne w celu sprawdzenia, czy również jesteśmy nosicielami tego zespołu⁵⁶. Wczesne wykrycie MEN1 może pomóc w monitorowaniu i wykryciu prolaktynoma we wczesnych stadiach⁷.

Chociaż nie ma znanych sposobów zapobiegania rozwojowi prolaktynoma, u osób z grupy wysokiego ryzyka (ze względu na pewne dziedziczne zespoły) mogą istnieć sposoby na wczesne wykrycie i leczenie, zanim spowodują problemy zdrowotne⁸.

Wczesna diagnostyka jako element profilaktyki

Wczesna diagnostyka, wraz z odpowiednim leczeniem, zawsze będzie najskuteczniejszym narzędziem w leczeniu prolaktynoma i osiąganiu optymalnych wyników⁹. U kobiet prolaktynoma często prowadzi do zaburzeń cyklu miesiączkowego, dzięki czemu jest zwykle wykrywana wcześniej niż u mężczyzn¹⁰.

Chociaż nie zawsze możliwe jest zapobieganie rozwojowi prolaktynoma, wczesne rozpoznanie dzięki świadomości objawów jest kluczowe dla skutecznego leczenia i zapobiegania długoterminowym powikłaniom¹¹.

Zmniejszenie ryzyka walopatii związanej z leczeniem kabergoliną

Walopatia związana z kabergoliną (CAV) jest definiowana przez echokardiograficzną triadę umiarkowanej lub ciężkiej niedomykalności, pogrubienia zastawek i ograniczonego ruchu zastawek. Ryzyko CAV, choć niewielkie, wymaga przemyślanego przepisywania terapii agonistami dopaminy w leczeniu prolaktynoma i rozważenia środków mających na celu zminimalizowanie ekspozycji na kabergolinę¹².

W celu zmniejszenia całkowitej ekspozycji na kabergolinę, a tym samym ryzyka CAV, należy rozważyć strategie długoterminowego postępowania, głównie operację, a czasem radioterapię. Endokrynolodzy powinni być świadomi ryzyka CAV. Cele leczenia obejmują przede wszystkim zmniejszenie guza, zachowanie wzroku i przywrócenie funkcji gonad¹³.

Postępowanie w ciąży u pacjentek z prolaktynoma

Szczególnym wyzwaniem jest planowanie ciąży u pacjentek z prolaktynoma. Większość kobiet z gruczolakami laktotrowowymi cierpi na bezpłodność anowulacyjną, a nawet jawny hipogonadyzm, ale może zajść w ciążę po leczeniu gruczolaka i obniżeniu stężenia prolaktyny w surowicy do wartości prawidłowych¹⁴.

Poradnictwo przed ciążą

Poradnictwo pacjentki przed ciążą powinno obejmować omówienie ryzyka wzrostu gruczolaka podczas ciąży oraz potencjalnego wpływu ekspozycji na agoniści dopaminy na płód (który jest bardzo niski)¹⁵. Postępowanie z pacjentką z gruczolakiem laktotropowym, która chce zajść w ciążę, powinno rozpocząć się od omówienia opcji obniżenia stężenia prolaktyny do normy (w celu przywrócenia owulacji) oraz poradnictwa dotyczącego potencjalnego ryzyka leczenia podczas ciąży dla niej i płodu¹⁶.

Głównym ryzykiem dla matki z gruczolakiem laktotropowym podczas ciąży jest zwiększenie rozmiaru gruczolaka wystarczające do wywołania objawów neurologicznych, przede wszystkim zaburzeń widzenia. Ryzyko, że zwiększenie rozmiaru gruczolaka laktotropowego będzie klinicznie istotne, zależy od rozmiaru gruczolaka przed ciążą. Dlatego wszystkie pacjentki z gruczolakiem laktotropowym powinny być leczone przed ciążą w celu obniżenia stężenia prolaktyny i zmniejszenia rozmiaru gruczolaka (w przypadku makrogruczolaków)¹⁷.

Postępowanie w zależności od rozmiaru guza

Prolaktynoma klasyfikowana jest jako mikroprolaktynoma, gdy jej wymiar wynosi ≤10 mm, i makroprolaktynoma, gdy wynosi >10 mm¹⁸.

W przypadku kobiet z mikrogruczolakami laktotropowymi, leczenie agonistą dopaminy zwykle normalizuje poziom prolaktyny, usuwając tym samym hamowanie wydzielania gonadotropin i przywracając normalną owulację i płodność. Dostępne dowody nie sugerują ryzyka dla płodu przy stosowaniu agonisty dopaminy w celu indukcji owulacji¹⁹. Zalecane jest przerwanie stosowania agonisty dopaminy u kobiet z mikrogruczolakiem po potwierdzeniu ciąży. Ze względu na ograniczoną liczbę pacjentek leczonych przez całą ciążę, bezpieczeństwo ciągłego stosowania nie zostało ustalone²⁰.

Ryzyko powikłań w przypadku mikroprolaktynoma jest niskie, dlatego zaleca się ścisłą obserwację pacjentki bez konieczności interwencji²¹.

W przypadku kobiet z makrogruczolakami, istotne jest poradnictwo wszystkich pacjentek, aby stosowały antykoncepcję barierową przez co najmniej 6 miesięcy do 1 roku po rozpoczęciu leczenia agonistą dopaminy²². Postępowanie w przypadku makroprolaktynoma powinno rozpocząć się od dobrego planowania przed ciążą²³.

U kobiet z dowodami wzrostu makrogruczolaka w rezonansie magnetycznym przysadki (wykonanym z powodu silnych bólów głowy lub nieprawidłowości w polu widzenia), zaleca się leczenie kabergoliną lub bromokryptyną przez pozostałą część ciąży. Operacja przezklinowa jest czasami konieczna, jeśli agoniści dopaminy nie są skuteczni, a wzrok jest poważnie zagrożony²⁴.

Najnowsze wytyczne zalecają przerwanie stosowania agonistów dopaminy u kobiet z mikrogruczolakami zaraz po potwierdzeniu ciąży, ponieważ doskonałe wyniki można osiągnąć przy ścisłym monitorowaniu klinicznym. Z kolei kobiety z dużymi makrogruczolakami i te z rozrostem pozasiodłowym muszą kontynuować terapię agonistami dopaminy przez całą ciążę, ponieważ ryzyko powiększenia guza jest stosunkowo wysokie²⁵.

Klasyfikacja ryzyka w makroprolaktynoma

Makroprolaktynoma o niskim ryzyku obejmuje przypadki spełniające wszystkie następujące kryteria:

Terapia agonistą dopaminy przez co najmniej 6 miesięcy przed ciążą²⁶
Niedawny rezonans magnetyczny (3 miesiące) przed ciążą pokazujący guz nieuciškający skrzyżowania nerwu wzrokowego ani niewnikający w otaczające struktury²⁷
Pacjentka prawdopodobnie będzie przychodzić na regularne wizyty kontrolne w okresie prenatalnym²⁸

Makroprolaktynoma o wysokim ryzyku obejmuje przypadki z którymkolwiek z następujących:

Terapia agonistą dopaminy przez ≤6 miesięcy lub nieregularnie, z dowodami niewielkiego lub zerowego zmniejszenia guza w niedawnym rezonansie magnetycznym²⁹
Rezonans magnetyczny przed ciążą pokazujący guz przylegający do skrzyżowania nerwu wzrokowego lub wnikający w otaczające struktury³⁰

Monitorowanie i postępowanie podczas ciąży

Nie zaleca się pomiaru poziomu prolaktyny podczas ciąży³¹. W przypadku pacjentek z makroprolaktynoma, ze względu na potencjalne ryzyko powiększenia guza, zaleca się wykonanie rezonansu magnetycznego przysadki bez gadolinu w trakcie ciąży, zwłaszcza gdy pojawią się objawy takie jak bóle głowy czy zaburzenia widzenia³².

Wybór kontynuowania leczenia kabergoliną może być bardzo skuteczny, ponieważ ułatwia przebieg ciąży, utrzymuje rozmiar guza i wiąże się z korzystnymi wynikami dla noworodka³³.

Postępowanie po porodzie i karmienie piersią

Karmienie piersią zwiększa stężenie prolaktyny w surowicy, ale nie wydaje się zwiększać ryzyka wzrostu gruczolaka laktotropowego. Dlatego karmienie piersią jest opcją dla kobiet z mikro- i makrogruczolakami, które pozostawały stabilne w rozmiarze podczas ciąży³⁴. Terapia agonistą dopaminy, która obniża stężenie prolaktyny i hamuje laktację, powinna być wstrzymana do zakończenia karmienia piersią³⁵.

Wzrost prolaktynoma podczas laktacji nie jest odnotowywany, a obecność prolaktynoma nie powinna być uważana za przeciwwskazanie do laktacji³⁶. Zaleca się pomiar poziomu prolaktyny w surowicy po 2 miesiącach od porodu i powtórzenie rezonansu magnetycznego siodła tureckiego z kontrastem 2 miesiące po zakończeniu laktacji³⁷.

Profilaktyka nawrotów i monitorowanie powikłań

Aby zapobiec nawrotom i monitorować powikłania, zalecane jest ciągłe monitorowanie prolaktynoma³⁸. Pomimo skutecznego leczenia, prolaktynoma może czasami nawracać (nawrót). Możliwe są również różne niepożądane skutki uboczne w wyniku leczenia. Może to prowadzić do niedoczynności przysadki po operacji lub radioterapii, co wymaga terapii zastępczej hormonami³⁹.

Makroprolaktynomy wymagają ściślejszego monitorowania niż mikroprolaktynomy, aby kontrolować, jak się zmieniają⁴⁰.

Opcje leczenia w zapobieganiu nawrotom

Terapia lekowa agonistami dopaminy jest głównym leczeniem guzów wydzielających prolaktynę (tzw. prolaktynoma). Większość guzów wydzielających prolaktynę dobrze reaguje na terapię lekową, więc zwykle jest to jedyne potrzebne leczenie⁴¹.

Operacja jest czasami stosowana w leczeniu guzów wydzielających prolaktynę, gdy terapia lekowa nie działa lub nie może być stosowana. W zależności od rozmiaru guza, wykonuje się operację przezklinową lub kraniotomię w celu usunięcia guza⁴².

Można również zaproponować radioterapię wiązką zewnętrzną w przypadku guzów wydzielających prolaktynę. Można ją stosować po operacji lub zamiast operacji⁴³.

Strategie minimalizacji ekspozycji na leki

Przy odpowiednim leczeniu, rokowanie dla osób z prolaktynoma jest bardzo obiecujące⁴⁴. Jednakże ważne jest, aby rozważyć odstawienie agonisty dopaminy tam, gdzie to właściwe, aby zminimalizować całkowitą ekspozycję na kabergolinę, a tym samym ryzyko walopatii związanej z kabergoliną⁴⁵.

Mimo że nie można zapobiec rozwojowi prolaktynoma, można wzmocnić swoje zdrowie i układ odpornościowy, utrzymując zdrowy tryb życia⁴⁶.

Chociaż dokładne przyczyny prolaktynoma nie są w pełni zrozumiałe, co utrudnia zapobieganie, istnieją kroki, które można podjąć, aby zmniejszyć ryzyko powikłań związanych z tym schorzeniem. Zarządzanie lekami, które mogą prowadzić do podwyższonego poziomu prolaktyny, takimi jak niektóre leki przeciwpsychotyczne i leki na wysokie ciśnienie krwi, jest jednym ze sposobów zapobiegania hiperprolaktynemii, kluczowemu objawowi prolaktynoma⁴⁷.

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Materiały źródłowe

#1 Prolactinoma: What It Is, Causes, Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/22007-prolactinoma
Unfortunately, theres nothing you can do to prevent developing prolactinoma. A known risk factor is having an inherited (passed through your biological family) condition called multiple endocrine neoplasia (MEN) type 1. […] If you have a first-degree relative (biological sibling or parent) who has this condition, you may want to get genetic counseling to check if you have it as well. This may help screen for and catch prolactinoma in its early phases.
#2 Can Pituitary Tumors Be Prevented? | American Cancer Society | American Cancer Society
https://www.cancer.org/cancer/types/pituitary-tumors/causes-risks-prevention/prevention.html
Certain lifestyle changes (such as staying at a healthy weight or not smoking) can lower the risk for many types of cancer. But pituitary tumors have not been linked with any known outside risk factors. Because of this, there is no known way to prevent these tumors at this time. […] Still, for people who have a high risk of pituitary tumors (because of certain inherited syndromes), there may be ways to find and treat them early, before they cause problems.
#3 Prolactinoma (pituitary tumor) – USZ
https://www.usz.ch/en/disease/prolactinoma/
As a prolactinoma often leads to menstrual cycle disorders, it is usually detected earlier in women than in men. Beyond that, however, there are no signs that make early detection possible. Experts have also not yet been able to fully explain the causes of prolactinoma. There are therefore no direct measures that can prevent the development of prolactinoma. However, you can strengthen your health and immune system by maintaining a healthy lifestyle. […] Despite successful treatment, a prolactinoma can sometimes recur (recurrence). Various undesirable side effects are also possible as a result of the treatment. This can lead to hypofunction of the pituitary gland after surgery or radiotherapy, which makes hormone replacement therapy necessary.
#4 Macroprolactinoma: Symptoms, Causes, Diagnosis, Treatment
https://www.healthline.com/health/macroprolactinoma
Most macroprolactinomas develop without a known cause. Theres no known way to prevent them, but a doctor may recommend regular monitoring if you have a family history of MEN1. […] Macroprolactinomas require closer follow-up than microprolactinomas to monitor how theyre changing.
#5 Prolactinoma: What It Is, Causes, Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/22007-prolactinoma
Unfortunately, theres nothing you can do to prevent developing prolactinoma. A known risk factor is having an inherited (passed through your biological family) condition called multiple endocrine neoplasia (MEN) type 1. […] If you have a first-degree relative (biological sibling or parent) who has this condition, you may want to get genetic counseling to check if you have it as well. This may help screen for and catch prolactinoma in its early phases.
#6 Prolactinoma: Causes, Symptoms & Treatment Options
https://www.truemeds.in/diseases/endocrine/prolactinoma-93
While the exact causes of prolactinoma are not fully understood, making prevention challenging, there are some steps that can be taken to reduce the risk of complications associated with this condition. Managing medications that can lead to elevated prolactin levels, such as certain antipsychotics and high blood pressure medications, is one way to help prevent hyperprolactinemia, a key symptom of prolactinomas. For individuals with familial syndromes like multiple endocrine neoplasia type 1 (MEN1), which increases the risk of developing prolactinomas, close monitoring is essential. Regular check-ups and screenings for those with a family history of pituitary tumours can facilitate early detection and timely treatment. […] Although prevention may not always be possible, early diagnosis through awareness of prolactinoma symptoms is crucial for effective management and the prevention of long-term complications.
#7 Macroprolactinoma: Symptoms, Causes, Diagnosis, Treatment
https://www.healthline.com/health/macroprolactinoma
Most macroprolactinomas develop without a known cause. Theres no known way to prevent them, but a doctor may recommend regular monitoring if you have a family history of MEN1. […] Macroprolactinomas require closer follow-up than microprolactinomas to monitor how theyre changing.
#8 Can Pituitary Tumors Be Prevented? | American Cancer Society | American Cancer Society
https://www.cancer.org/cancer/types/pituitary-tumors/causes-risks-prevention/prevention.html
Certain lifestyle changes (such as staying at a healthy weight or not smoking) can lower the risk for many types of cancer. But pituitary tumors have not been linked with any known outside risk factors. Because of this, there is no known way to prevent these tumors at this time. […] Still, for people who have a high risk of pituitary tumors (because of certain inherited syndromes), there may be ways to find and treat them early, before they cause problems.
#9 Prolactinoma – Symptoms, Diagnosis, TreatmentSecond Opinion Iconphone iconSecond Opinion IconGroup 49
https://www.barrowneuro.org/condition/prolactinoma/
Can a prolactinoma be prevented? There arenât any known preventative steps to keep prolactinomas at bay. That said, an early diagnosis, accompanied by appropriate treatment, will always be the most effective tool in treating a condition and reaching an optimal outcome. […] With the proper treatment, the prognosis for those with prolactinoma is very promising. […] To prevent recurrence and monitor for complications, ongoing monitoring of prolactinomas is recommended.
#10 Prolactinoma (pituitary tumor) – USZ
https://www.usz.ch/en/disease/prolactinoma/
As a prolactinoma often leads to menstrual cycle disorders, it is usually detected earlier in women than in men. Beyond that, however, there are no signs that make early detection possible. Experts have also not yet been able to fully explain the causes of prolactinoma. There are therefore no direct measures that can prevent the development of prolactinoma. However, you can strengthen your health and immune system by maintaining a healthy lifestyle. […] Despite successful treatment, a prolactinoma can sometimes recur (recurrence). Various undesirable side effects are also possible as a result of the treatment. This can lead to hypofunction of the pituitary gland after surgery or radiotherapy, which makes hormone replacement therapy necessary.
#11 Prolactinoma: Causes, Symptoms & Treatment Options
https://www.truemeds.in/diseases/endocrine/prolactinoma-93
While the exact causes of prolactinoma are not fully understood, making prevention challenging, there are some steps that can be taken to reduce the risk of complications associated with this condition. Managing medications that can lead to elevated prolactin levels, such as certain antipsychotics and high blood pressure medications, is one way to help prevent hyperprolactinemia, a key symptom of prolactinomas. For individuals with familial syndromes like multiple endocrine neoplasia type 1 (MEN1), which increases the risk of developing prolactinomas, close monitoring is essential. Regular check-ups and screenings for those with a family history of pituitary tumours can facilitate early detection and timely treatment. […] Although prevention may not always be possible, early diagnosis through awareness of prolactinoma symptoms is crucial for effective management and the prevention of long-term complications.
#12 Cabergoline-associated valvulopathy of the tricuspid valve in the treatment of prolactinoma in: Endocrine Oncology Volume 3 Issue 1 (2023)
https://eo.bioscientifica.com/view/journals/eo/3/1/EO-22-0086.xml
Cabergoline-associated valvulopathy (CAV) is defined by the echocardiographic triad of moderate or severe regurgitation, valvular thickening and restricted valvular motion. […] The risk of CAV, although small, prompts a mindful prescription of dopamine agonist therapy for prolactinomas and consideration of measures to minimise cabergoline exposure. […] Long-term management strategies chiefly surgery, sometimes radiotherapy should be considered in patients to minimise overall cabergoline exposure. […] Endocrinologists should be cognisant of the risk of CAV. […] The goals of treatment primarily include tumour shrinkage, preservation of vision and restoration of gonadal function. […] Consideration of DA withdrawal is important where appropriate to minimise overall cabergoline exposure and thus CAV risk. […] More broadly, the risk of CAV, although small, prompts a mindful prescription of DA therapy for prolactinoma.
#13 Cabergoline-associated valvulopathy of the tricuspid valve in the treatment of prolactinoma in: Endocrine Oncology Volume 3 Issue 1 (2023)
https://eo.bioscientifica.com/view/journals/eo/3/1/EO-22-0086.xml
Cabergoline-associated valvulopathy (CAV) is defined by the echocardiographic triad of moderate or severe regurgitation, valvular thickening and restricted valvular motion. […] The risk of CAV, although small, prompts a mindful prescription of dopamine agonist therapy for prolactinomas and consideration of measures to minimise cabergoline exposure. […] Long-term management strategies chiefly surgery, sometimes radiotherapy should be considered in patients to minimise overall cabergoline exposure. […] Endocrinologists should be cognisant of the risk of CAV. […] The goals of treatment primarily include tumour shrinkage, preservation of vision and restoration of gonadal function. […] Consideration of DA withdrawal is important where appropriate to minimise overall cabergoline exposure and thus CAV risk. […] More broadly, the risk of CAV, although small, prompts a mindful prescription of DA therapy for prolactinoma.
#14 Management of lactotroph adenoma (prolactinoma) before and during pregnancy – UpToDate
https://www.uptodate.com/contents/management-of-lactotroph-adenoma-prolactinoma-before-and-during-pregnancy
Most women with lactotroph adenomas have anovulatory infertility and even frank hypogonadism but are able to conceive once the lactotroph adenoma has been treated and the serum prolactin concentration has been lowered to normal. Patient counseling before pregnancy should include a discussion about the risks of adenoma growth during pregnancy and the potential effects of exposure to dopamine agonists on the fetus (which is very low). […] Management of a patient with lactotroph adenoma who wants to conceive should begin with a discussion about options for lowering serum prolactin to normal (to restore ovulation) and counseling about the potential risks of treatment during pregnancy to her and the fetus. The principal risk during pregnancy to a mother with a lactotroph adenoma is an increase in adenoma size sufficient to cause neurologic symptoms, most importantly visual impairment. The risk that an increase in lactotroph adenoma size will be clinically important depends upon the size of the adenoma before pregnancy. Thus, all patients with a lactotroph adenoma should be treated prior to pursuing pregnancy to lower serum prolactin concentrations and decrease adenoma size (macroadenomas).
#15 Management of lactotroph adenoma (prolactinoma) before and during pregnancy – UpToDate
https://www.uptodate.com/contents/management-of-lactotroph-adenoma-prolactinoma-before-and-during-pregnancy
Most women with lactotroph adenomas have anovulatory infertility and even frank hypogonadism but are able to conceive once the lactotroph adenoma has been treated and the serum prolactin concentration has been lowered to normal. Patient counseling before pregnancy should include a discussion about the risks of adenoma growth during pregnancy and the potential effects of exposure to dopamine agonists on the fetus (which is very low). […] Management of a patient with lactotroph adenoma who wants to conceive should begin with a discussion about options for lowering serum prolactin to normal (to restore ovulation) and counseling about the potential risks of treatment during pregnancy to her and the fetus. The principal risk during pregnancy to a mother with a lactotroph adenoma is an increase in adenoma size sufficient to cause neurologic symptoms, most importantly visual impairment. The risk that an increase in lactotroph adenoma size will be clinically important depends upon the size of the adenoma before pregnancy. Thus, all patients with a lactotroph adenoma should be treated prior to pursuing pregnancy to lower serum prolactin concentrations and decrease adenoma size (macroadenomas).
#16 Management of lactotroph adenoma (prolactinoma) before and during pregnancy – UpToDate
https://www.uptodate.com/contents/management-of-lactotroph-adenoma-prolactinoma-before-and-during-pregnancy
Most women with lactotroph adenomas have anovulatory infertility and even frank hypogonadism but are able to conceive once the lactotroph adenoma has been treated and the serum prolactin concentration has been lowered to normal. Patient counseling before pregnancy should include a discussion about the risks of adenoma growth during pregnancy and the potential effects of exposure to dopamine agonists on the fetus (which is very low). […] Management of a patient with lactotroph adenoma who wants to conceive should begin with a discussion about options for lowering serum prolactin to normal (to restore ovulation) and counseling about the potential risks of treatment during pregnancy to her and the fetus. The principal risk during pregnancy to a mother with a lactotroph adenoma is an increase in adenoma size sufficient to cause neurologic symptoms, most importantly visual impairment. The risk that an increase in lactotroph adenoma size will be clinically important depends upon the size of the adenoma before pregnancy. Thus, all patients with a lactotroph adenoma should be treated prior to pursuing pregnancy to lower serum prolactin concentrations and decrease adenoma size (macroadenomas).
#17 Management of lactotroph adenoma (prolactinoma) before and during pregnancy – UpToDate
https://www.uptodate.com/contents/management-of-lactotroph-adenoma-prolactinoma-before-and-during-pregnancy
Most women with lactotroph adenomas have anovulatory infertility and even frank hypogonadism but are able to conceive once the lactotroph adenoma has been treated and the serum prolactin concentration has been lowered to normal. Patient counseling before pregnancy should include a discussion about the risks of adenoma growth during pregnancy and the potential effects of exposure to dopamine agonists on the fetus (which is very low). […] Management of a patient with lactotroph adenoma who wants to conceive should begin with a discussion about options for lowering serum prolactin to normal (to restore ovulation) and counseling about the potential risks of treatment during pregnancy to her and the fetus. The principal risk during pregnancy to a mother with a lactotroph adenoma is an increase in adenoma size sufficient to cause neurologic symptoms, most importantly visual impairment. The risk that an increase in lactotroph adenoma size will be clinically important depends upon the size of the adenoma before pregnancy. Thus, all patients with a lactotroph adenoma should be treated prior to pursuing pregnancy to lower serum prolactin concentrations and decrease adenoma size (macroadenomas).
#18
https://journals.lww.com/jihs/fulltext/2015/03010/management_of_prolactinoma_during_pregnancy_and.2.aspx
Prolactinoma is classified as microprolactinoma when it measures 10 mm and macroprolactinoma when it measures 10 mm. […] In case of microprolactinoma, the risk of complications are low hence it is recommended to keep a close follow up of patient without any need for intervention. […] It is essential to counsel all patients with macroprolactinoma to use barrier contraceptive for at least 6 months to 1 year after starting treatment with Dopamine agonist. […] Hence management of macroprolactinoma should begin with good planning before pregnancy. […] It is not recommended to measure prolactin level during pregnancy. […] The other problem with prolactinoma during pregnancy is the potential effects of dopamine agonist on the fetus. […] The decision whether to continue dopamine agonist during pregnancy is unclear.
#19 Management of lactotroph adenoma (prolactinoma) before and during pregnancy – UpToDate
https://www.uptodate.com/contents/management-of-lactotroph-adenoma-prolactinoma-before-and-during-pregnancy
For women with lactotroph microadenomas, treatment with a dopamine agonist usually normalizes prolactin and thereby removes the inhibition of gonadotropin secretion and restores normal ovulation and fertility. As noted, available evidence does not suggest risk to the fetus from dopamine agonist use for ovulation induction. […] A dopamine agonist is the treatment of choice for women with a lactotroph adenoma. A marked reduction in the serum prolactin concentration often occurs within two to three weeks. Restoration of ovulation occurs in over 90 percent of women with hyperprolactinemia and anovulation. […] We suggest stopping the dopamine agonist in women with a microadenoma once pregnancy has been confirmed. Because of the limited number of patients who have been treated throughout pregnancy, the safety of continued usage has not been established.
#20 Management of lactotroph adenoma (prolactinoma) before and during pregnancy – UpToDate
https://www.uptodate.com/contents/management-of-lactotroph-adenoma-prolactinoma-before-and-during-pregnancy
For women with lactotroph microadenomas, treatment with a dopamine agonist usually normalizes prolactin and thereby removes the inhibition of gonadotropin secretion and restores normal ovulation and fertility. As noted, available evidence does not suggest risk to the fetus from dopamine agonist use for ovulation induction. […] A dopamine agonist is the treatment of choice for women with a lactotroph adenoma. A marked reduction in the serum prolactin concentration often occurs within two to three weeks. Restoration of ovulation occurs in over 90 percent of women with hyperprolactinemia and anovulation. […] We suggest stopping the dopamine agonist in women with a microadenoma once pregnancy has been confirmed. Because of the limited number of patients who have been treated throughout pregnancy, the safety of continued usage has not been established.
#21
https://journals.lww.com/jihs/fulltext/2015/03010/management_of_prolactinoma_during_pregnancy_and.2.aspx
Prolactinoma is classified as microprolactinoma when it measures 10 mm and macroprolactinoma when it measures 10 mm. […] In case of microprolactinoma, the risk of complications are low hence it is recommended to keep a close follow up of patient without any need for intervention. […] It is essential to counsel all patients with macroprolactinoma to use barrier contraceptive for at least 6 months to 1 year after starting treatment with Dopamine agonist. […] Hence management of macroprolactinoma should begin with good planning before pregnancy. […] It is not recommended to measure prolactin level during pregnancy. […] The other problem with prolactinoma during pregnancy is the potential effects of dopamine agonist on the fetus. […] The decision whether to continue dopamine agonist during pregnancy is unclear.
#22
https://journals.lww.com/jihs/fulltext/2015/03010/management_of_prolactinoma_during_pregnancy_and.2.aspx
Prolactinoma is classified as microprolactinoma when it measures 10 mm and macroprolactinoma when it measures 10 mm. […] In case of microprolactinoma, the risk of complications are low hence it is recommended to keep a close follow up of patient without any need for intervention. […] It is essential to counsel all patients with macroprolactinoma to use barrier contraceptive for at least 6 months to 1 year after starting treatment with Dopamine agonist. […] Hence management of macroprolactinoma should begin with good planning before pregnancy. […] It is not recommended to measure prolactin level during pregnancy. […] The other problem with prolactinoma during pregnancy is the potential effects of dopamine agonist on the fetus. […] The decision whether to continue dopamine agonist during pregnancy is unclear.
#23
https://journals.lww.com/jihs/fulltext/2015/03010/management_of_prolactinoma_during_pregnancy_and.2.aspx
Prolactinoma is classified as microprolactinoma when it measures 10 mm and macroprolactinoma when it measures 10 mm. […] In case of microprolactinoma, the risk of complications are low hence it is recommended to keep a close follow up of patient without any need for intervention. […] It is essential to counsel all patients with macroprolactinoma to use barrier contraceptive for at least 6 months to 1 year after starting treatment with Dopamine agonist. […] Hence management of macroprolactinoma should begin with good planning before pregnancy. […] It is not recommended to measure prolactin level during pregnancy. […] The other problem with prolactinoma during pregnancy is the potential effects of dopamine agonist on the fetus. […] The decision whether to continue dopamine agonist during pregnancy is unclear.
#24 Management of lactotroph adenoma (prolactinoma) before and during pregnancy – UpToDate
https://www.uptodate.com/contents/management-of-lactotroph-adenoma-prolactinoma-before-and-during-pregnancy
For women with evidence of macroadenoma growth on pituitary MRI (performed for severe headaches or visual field abnormalities), we suggest treatment with cabergoline or bromocriptine throughout the remainder of the pregnancy. Transsphenoidal surgery is sometimes needed if dopamine agonists are not successful and vision is severely compromised. […] Breastfeeding increases serum prolactin concentrations but does not appear to increase the risk of lactotroph adenoma growth. Therefore, breastfeeding is an option for women with micro- and macroadenomas that remained stable in size during pregnancy. Dopamine agonist therapy, which lowers serum prolactin and inhibits lactation, should be withheld until breastfeeding is completed.
#25 Beat the giant: case of a giant prolactinoma during pregnancy on cabergoline in: Endocrinology, Diabetes & Metabolism Case Reports Volume 2018 Issue 1 (2018)
https://edm.bioscientifica.com/view/journals/edm/2018/1/EDM18-0099.xml
The choice to continue CAB was very effective, as it facilitated the course of the pregnancy, maintained the tumor size in this patient and was associated with favorable neonatal outcomes. […] The latest guidelines recommend discontinuing DA in women with microadenomas as soon as pregnancy is confirmed, as excellent outcomes can be achieved with close clinical monitoring. Conversely, women with large macroadenomas and those with extrasellar extensions need to continue DA therapy throughout the pregnancy, as the risk of tumor enlargement is relatively high. […] In our patient, treatment with CAB had to continue, as the patient did not demonstrate tumor shrinkage after pregnancy.
#26
https://journals.lww.com/jihs/fulltext/2015/03010/management_of_prolactinoma_during_pregnancy_and.2.aspx
Macroprolactinoma with low risk features include those who full fill all of the following criteria- a) Taken dopamine agonist therapy for at least 6 month before pregnancy b) Recent MRI (3 month) before pregnancy showing tumor not compressing upon the optic chiasma or invading the surrounding structures c) Patient likely to come for regular antenatal follow up. […] Macroprolactinoma with high risk features include those with any of the following a) Taken dopamine agonist therapy for 6 months or irregularly with evidence of little or no tumor shrinkage on recent MRI b) MRI before pregnancy showing tumor abutting the optic chiasma or invading the surrounding structures. […] Management of prolactinoma postpartum depends on whether patient wants to continue breastfeeding. […] Growth of prolactinoma during lactation is not reported and presence of prolactinoma should not be considered as contraindication for lactation. […] It is recommended to measure serum PRL after 2 months of delivery and repeat a MRI Sella with contrast 2 months after stopping lactation.
#27
https://journals.lww.com/jihs/fulltext/2015/03010/management_of_prolactinoma_during_pregnancy_and.2.aspx
Macroprolactinoma with low risk features include those who full fill all of the following criteria- a) Taken dopamine agonist therapy for at least 6 month before pregnancy b) Recent MRI (3 month) before pregnancy showing tumor not compressing upon the optic chiasma or invading the surrounding structures c) Patient likely to come for regular antenatal follow up. […] Macroprolactinoma with high risk features include those with any of the following a) Taken dopamine agonist therapy for 6 months or irregularly with evidence of little or no tumor shrinkage on recent MRI b) MRI before pregnancy showing tumor abutting the optic chiasma or invading the surrounding structures. […] Management of prolactinoma postpartum depends on whether patient wants to continue breastfeeding. […] Growth of prolactinoma during lactation is not reported and presence of prolactinoma should not be considered as contraindication for lactation. […] It is recommended to measure serum PRL after 2 months of delivery and repeat a MRI Sella with contrast 2 months after stopping lactation.
#28
https://journals.lww.com/jihs/fulltext/2015/03010/management_of_prolactinoma_during_pregnancy_and.2.aspx
Macroprolactinoma with low risk features include those who full fill all of the following criteria- a) Taken dopamine agonist therapy for at least 6 month before pregnancy b) Recent MRI (3 month) before pregnancy showing tumor not compressing upon the optic chiasma or invading the surrounding structures c) Patient likely to come for regular antenatal follow up. […] Macroprolactinoma with high risk features include those with any of the following a) Taken dopamine agonist therapy for 6 months or irregularly with evidence of little or no tumor shrinkage on recent MRI b) MRI before pregnancy showing tumor abutting the optic chiasma or invading the surrounding structures. […] Management of prolactinoma postpartum depends on whether patient wants to continue breastfeeding. […] Growth of prolactinoma during lactation is not reported and presence of prolactinoma should not be considered as contraindication for lactation. […] It is recommended to measure serum PRL after 2 months of delivery and repeat a MRI Sella with contrast 2 months after stopping lactation.
#29
https://journals.lww.com/jihs/fulltext/2015/03010/management_of_prolactinoma_during_pregnancy_and.2.aspx
Macroprolactinoma with low risk features include those who full fill all of the following criteria- a) Taken dopamine agonist therapy for at least 6 month before pregnancy b) Recent MRI (3 month) before pregnancy showing tumor not compressing upon the optic chiasma or invading the surrounding structures c) Patient likely to come for regular antenatal follow up. […] Macroprolactinoma with high risk features include those with any of the following a) Taken dopamine agonist therapy for 6 months or irregularly with evidence of little or no tumor shrinkage on recent MRI b) MRI before pregnancy showing tumor abutting the optic chiasma or invading the surrounding structures. […] Management of prolactinoma postpartum depends on whether patient wants to continue breastfeeding. […] Growth of prolactinoma during lactation is not reported and presence of prolactinoma should not be considered as contraindication for lactation. […] It is recommended to measure serum PRL after 2 months of delivery and repeat a MRI Sella with contrast 2 months after stopping lactation.
#30
https://journals.lww.com/jihs/fulltext/2015/03010/management_of_prolactinoma_during_pregnancy_and.2.aspx
Macroprolactinoma with low risk features include those who full fill all of the following criteria- a) Taken dopamine agonist therapy for at least 6 month before pregnancy b) Recent MRI (3 month) before pregnancy showing tumor not compressing upon the optic chiasma or invading the surrounding structures c) Patient likely to come for regular antenatal follow up. […] Macroprolactinoma with high risk features include those with any of the following a) Taken dopamine agonist therapy for 6 months or irregularly with evidence of little or no tumor shrinkage on recent MRI b) MRI before pregnancy showing tumor abutting the optic chiasma or invading the surrounding structures. […] Management of prolactinoma postpartum depends on whether patient wants to continue breastfeeding. […] Growth of prolactinoma during lactation is not reported and presence of prolactinoma should not be considered as contraindication for lactation. […] It is recommended to measure serum PRL after 2 months of delivery and repeat a MRI Sella with contrast 2 months after stopping lactation.
#31
https://journals.lww.com/jihs/fulltext/2015/03010/management_of_prolactinoma_during_pregnancy_and.2.aspx
Prolactinoma is classified as microprolactinoma when it measures 10 mm and macroprolactinoma when it measures 10 mm. […] In case of microprolactinoma, the risk of complications are low hence it is recommended to keep a close follow up of patient without any need for intervention. […] It is essential to counsel all patients with macroprolactinoma to use barrier contraceptive for at least 6 months to 1 year after starting treatment with Dopamine agonist. […] Hence management of macroprolactinoma should begin with good planning before pregnancy. […] It is not recommended to measure prolactin level during pregnancy. […] The other problem with prolactinoma during pregnancy is the potential effects of dopamine agonist on the fetus. […] The decision whether to continue dopamine agonist during pregnancy is unclear.
#32 Beat the giant: case of a giant prolactinoma during pregnancy on cabergoline in: Endocrinology, Diabetes & Metabolism Case Reports Volume 2018 Issue 1 (2018)
https://edm.bioscientifica.com/view/journals/edm/2018/1/EDM18-0099.xml
Giant prolactinomas are a rare entity; during pregnancy, the risk for complications associated with these tumors is higher. This patient was treated with cabergoline to prevent tumor expansion in pregnancy, resulting in the uneventful delivery of a healthy baby boy. […] This case demonstrates the effectiveness and safety of CAB therapy during pregnancy. […] It is recommended that patients discontinue DA therapy once pregnancy is confirmed, usually 12 weeks after a missed period, limiting potential fetal exposure to only 34 weeks. […] The Endocrine Society guidelines recommend discontinuing DAs as soon as pregnancy is confirmed, except for women harboring invasive macroprolactinomas or in patients with evidence of tumor growth and visual and/or headache complaints. […] Given the potential risk of tumor enlargement, an MRI pituitary was performed without gadolinium at 26 weeks of gestation which showed a slight increase in adenoma size, but no headaches or visual disturbances were reported.
#33 Beat the giant: case of a giant prolactinoma during pregnancy on cabergoline in: Endocrinology, Diabetes & Metabolism Case Reports Volume 2018 Issue 1 (2018)
https://edm.bioscientifica.com/view/journals/edm/2018/1/EDM18-0099.xml
The choice to continue CAB was very effective, as it facilitated the course of the pregnancy, maintained the tumor size in this patient and was associated with favorable neonatal outcomes. […] The latest guidelines recommend discontinuing DA in women with microadenomas as soon as pregnancy is confirmed, as excellent outcomes can be achieved with close clinical monitoring. Conversely, women with large macroadenomas and those with extrasellar extensions need to continue DA therapy throughout the pregnancy, as the risk of tumor enlargement is relatively high. […] In our patient, treatment with CAB had to continue, as the patient did not demonstrate tumor shrinkage after pregnancy.
#34 Management of lactotroph adenoma (prolactinoma) before and during pregnancy – UpToDate
https://www.uptodate.com/contents/management-of-lactotroph-adenoma-prolactinoma-before-and-during-pregnancy
For women with evidence of macroadenoma growth on pituitary MRI (performed for severe headaches or visual field abnormalities), we suggest treatment with cabergoline or bromocriptine throughout the remainder of the pregnancy. Transsphenoidal surgery is sometimes needed if dopamine agonists are not successful and vision is severely compromised. […] Breastfeeding increases serum prolactin concentrations but does not appear to increase the risk of lactotroph adenoma growth. Therefore, breastfeeding is an option for women with micro- and macroadenomas that remained stable in size during pregnancy. Dopamine agonist therapy, which lowers serum prolactin and inhibits lactation, should be withheld until breastfeeding is completed.
#35 Management of lactotroph adenoma (prolactinoma) before and during pregnancy – UpToDate
https://www.uptodate.com/contents/management-of-lactotroph-adenoma-prolactinoma-before-and-during-pregnancy
For women with evidence of macroadenoma growth on pituitary MRI (performed for severe headaches or visual field abnormalities), we suggest treatment with cabergoline or bromocriptine throughout the remainder of the pregnancy. Transsphenoidal surgery is sometimes needed if dopamine agonists are not successful and vision is severely compromised. […] Breastfeeding increases serum prolactin concentrations but does not appear to increase the risk of lactotroph adenoma growth. Therefore, breastfeeding is an option for women with micro- and macroadenomas that remained stable in size during pregnancy. Dopamine agonist therapy, which lowers serum prolactin and inhibits lactation, should be withheld until breastfeeding is completed.
#36
https://journals.lww.com/jihs/fulltext/2015/03010/management_of_prolactinoma_during_pregnancy_and.2.aspx
Macroprolactinoma with low risk features include those who full fill all of the following criteria- a) Taken dopamine agonist therapy for at least 6 month before pregnancy b) Recent MRI (3 month) before pregnancy showing tumor not compressing upon the optic chiasma or invading the surrounding structures c) Patient likely to come for regular antenatal follow up. […] Macroprolactinoma with high risk features include those with any of the following a) Taken dopamine agonist therapy for 6 months or irregularly with evidence of little or no tumor shrinkage on recent MRI b) MRI before pregnancy showing tumor abutting the optic chiasma or invading the surrounding structures. […] Management of prolactinoma postpartum depends on whether patient wants to continue breastfeeding. […] Growth of prolactinoma during lactation is not reported and presence of prolactinoma should not be considered as contraindication for lactation. […] It is recommended to measure serum PRL after 2 months of delivery and repeat a MRI Sella with contrast 2 months after stopping lactation.
#37
https://journals.lww.com/jihs/fulltext/2015/03010/management_of_prolactinoma_during_pregnancy_and.2.aspx
Macroprolactinoma with low risk features include those who full fill all of the following criteria- a) Taken dopamine agonist therapy for at least 6 month before pregnancy b) Recent MRI (3 month) before pregnancy showing tumor not compressing upon the optic chiasma or invading the surrounding structures c) Patient likely to come for regular antenatal follow up. […] Macroprolactinoma with high risk features include those with any of the following a) Taken dopamine agonist therapy for 6 months or irregularly with evidence of little or no tumor shrinkage on recent MRI b) MRI before pregnancy showing tumor abutting the optic chiasma or invading the surrounding structures. […] Management of prolactinoma postpartum depends on whether patient wants to continue breastfeeding. […] Growth of prolactinoma during lactation is not reported and presence of prolactinoma should not be considered as contraindication for lactation. […] It is recommended to measure serum PRL after 2 months of delivery and repeat a MRI Sella with contrast 2 months after stopping lactation.
#38 Prolactinoma – Symptoms, Diagnosis, TreatmentSecond Opinion Iconphone iconSecond Opinion IconGroup 49
https://www.barrowneuro.org/condition/prolactinoma/
Can a prolactinoma be prevented? There arenât any known preventative steps to keep prolactinomas at bay. That said, an early diagnosis, accompanied by appropriate treatment, will always be the most effective tool in treating a condition and reaching an optimal outcome. […] With the proper treatment, the prognosis for those with prolactinoma is very promising. […] To prevent recurrence and monitor for complications, ongoing monitoring of prolactinomas is recommended.
#39 Prolactinoma (pituitary tumor) – USZ
https://www.usz.ch/en/disease/prolactinoma/
As a prolactinoma often leads to menstrual cycle disorders, it is usually detected earlier in women than in men. Beyond that, however, there are no signs that make early detection possible. Experts have also not yet been able to fully explain the causes of prolactinoma. There are therefore no direct measures that can prevent the development of prolactinoma. However, you can strengthen your health and immune system by maintaining a healthy lifestyle. […] Despite successful treatment, a prolactinoma can sometimes recur (recurrence). Various undesirable side effects are also possible as a result of the treatment. This can lead to hypofunction of the pituitary gland after surgery or radiotherapy, which makes hormone replacement therapy necessary.
#40 Macroprolactinoma: Symptoms, Causes, Diagnosis, Treatment
https://www.healthline.com/health/macroprolactinoma
Most macroprolactinomas develop without a known cause. Theres no known way to prevent them, but a doctor may recommend regular monitoring if you have a family history of MEN1. […] Macroprolactinomas require closer follow-up than microprolactinomas to monitor how theyre changing.
#41 Treatments for pituitary neuroendocrine tumours (PitNETs) | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/pituitary-gland-tumours/treatment/pituitary-neuroendocrine-tumours
Drug therapy with dopamine agonists is the main treatment for prolactin-producing tumours (also called prolactinomas). Most prolactin-producing tumours respond well to drug therapy, so it is usually the only treatment needed. […] Surgery is sometimes used to treat prolactin-producing tumours when drug therapy doesn’t work or can’t be used. Depending on the size of the tumour, transsphenoidal surgery or a craniotomy is done to remove the tumour. […] You may be offered external beam radiation therapy for prolactin-producing tumours. It can be used after surgery or instead of surgery.
#42 Treatments for pituitary neuroendocrine tumours (PitNETs) | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/pituitary-gland-tumours/treatment/pituitary-neuroendocrine-tumours
Drug therapy with dopamine agonists is the main treatment for prolactin-producing tumours (also called prolactinomas). Most prolactin-producing tumours respond well to drug therapy, so it is usually the only treatment needed. […] Surgery is sometimes used to treat prolactin-producing tumours when drug therapy doesn’t work or can’t be used. Depending on the size of the tumour, transsphenoidal surgery or a craniotomy is done to remove the tumour. […] You may be offered external beam radiation therapy for prolactin-producing tumours. It can be used after surgery or instead of surgery.
#43 Treatments for pituitary neuroendocrine tumours (PitNETs) | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/pituitary-gland-tumours/treatment/pituitary-neuroendocrine-tumours
Drug therapy with dopamine agonists is the main treatment for prolactin-producing tumours (also called prolactinomas). Most prolactin-producing tumours respond well to drug therapy, so it is usually the only treatment needed. […] Surgery is sometimes used to treat prolactin-producing tumours when drug therapy doesn’t work or can’t be used. Depending on the size of the tumour, transsphenoidal surgery or a craniotomy is done to remove the tumour. […] You may be offered external beam radiation therapy for prolactin-producing tumours. It can be used after surgery or instead of surgery.
#44 Prolactinoma – Symptoms, Diagnosis, TreatmentSecond Opinion Iconphone iconSecond Opinion IconGroup 49
https://www.barrowneuro.org/condition/prolactinoma/
Can a prolactinoma be prevented? There arenât any known preventative steps to keep prolactinomas at bay. That said, an early diagnosis, accompanied by appropriate treatment, will always be the most effective tool in treating a condition and reaching an optimal outcome. […] With the proper treatment, the prognosis for those with prolactinoma is very promising. […] To prevent recurrence and monitor for complications, ongoing monitoring of prolactinomas is recommended.
#45 Cabergoline-associated valvulopathy of the tricuspid valve in the treatment of prolactinoma in: Endocrine Oncology Volume 3 Issue 1 (2023)
https://eo.bioscientifica.com/view/journals/eo/3/1/EO-22-0086.xml
Cabergoline-associated valvulopathy (CAV) is defined by the echocardiographic triad of moderate or severe regurgitation, valvular thickening and restricted valvular motion. […] The risk of CAV, although small, prompts a mindful prescription of dopamine agonist therapy for prolactinomas and consideration of measures to minimise cabergoline exposure. […] Long-term management strategies chiefly surgery, sometimes radiotherapy should be considered in patients to minimise overall cabergoline exposure. […] Endocrinologists should be cognisant of the risk of CAV. […] The goals of treatment primarily include tumour shrinkage, preservation of vision and restoration of gonadal function. […] Consideration of DA withdrawal is important where appropriate to minimise overall cabergoline exposure and thus CAV risk. […] More broadly, the risk of CAV, although small, prompts a mindful prescription of DA therapy for prolactinoma.
#46 Prolactinoma (pituitary tumor) – USZ
https://www.usz.ch/en/disease/prolactinoma/
As a prolactinoma often leads to menstrual cycle disorders, it is usually detected earlier in women than in men. Beyond that, however, there are no signs that make early detection possible. Experts have also not yet been able to fully explain the causes of prolactinoma. There are therefore no direct measures that can prevent the development of prolactinoma. However, you can strengthen your health and immune system by maintaining a healthy lifestyle. […] Despite successful treatment, a prolactinoma can sometimes recur (recurrence). Various undesirable side effects are also possible as a result of the treatment. This can lead to hypofunction of the pituitary gland after surgery or radiotherapy, which makes hormone replacement therapy necessary.
#47 Prolactinoma: Causes, Symptoms & Treatment Options
https://www.truemeds.in/diseases/endocrine/prolactinoma-93
While the exact causes of prolactinoma are not fully understood, making prevention challenging, there are some steps that can be taken to reduce the risk of complications associated with this condition. Managing medications that can lead to elevated prolactin levels, such as certain antipsychotics and high blood pressure medications, is one way to help prevent hyperprolactinemia, a key symptom of prolactinomas. For individuals with familial syndromes like multiple endocrine neoplasia type 1 (MEN1), which increases the risk of developing prolactinomas, close monitoring is essential. Regular check-ups and screenings for those with a family history of pituitary tumours can facilitate early detection and timely treatment. […] Although prevention may not always be possible, early diagnosis through awareness of prolactinoma symptoms is crucial for effective management and the prevention of long-term complications.