Controversial issues in the management of hyperprolactinemia and prolactinomas - An overview by the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism.

@article{Vilar2018ControversialII,
  title={Controversial issues in the management of hyperprolactinemia and prolactinomas - An overview by the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism.},
  author={Lucio Vilar and Julio Abucham and Jos{\'e} Luciano Albuquerque and Luiz Ant{\^o}nio de Ara{\'u}jo and Monalisa Ferreira Azevedo and C{\'e}sar Luiz Boguszewski and Luiz Augusto Casulari and Malebranche B C Cunha Neto and Mauro Antonio Czepielewski and Felipe Gaia Duarte and Manuel Dos Santos Faria and M{\^o}nica Roberto Gadelha and Heraldo Mendes Garmes and Andr{\'e}a Glezer and Maria Helane Costa Gurgel and Raquel Soares Jallad and Manoel Ricardo Alves Martins and Paulo Augusto Carvalho Miranda and Renan Magalh{\~a}es Montenegro and Nina Rosa Musolino and Luciana Ansaneli Naves and Antonio Ribeiro-Oliveira Junior and C{\'i}ntia M S Silva and Camila Viecceli and Marcello Delano Bronstein},
  journal={Archives of endocrinology and metabolism},
  year={2018},
  volume={62 2},
  pages={
          236-263
        }
}
Prolactinomas are the most common pituitary adenomas (approximately 40% of cases), and they represent an important cause of hypogonadism and infertility in both sexes. The magnitude of prolactin (PRL) elevation can be useful in determining the etiology of hyperprolactinemia. Indeed, PRL levels > 250 ng/mL are highly suggestive of the presence of a prolactinoma. In contrast, most patients with stalk dysfunction, drug-induced hyperprolactinemia or systemic diseases present with PRL levels < 100… Expand
Pitfalls in the Diagnostic Evaluation of Hyperprolactinemia
TLDR
The screening for macroprolactin is indicated not only for asymptomatic subjects but also for those without an obvious cause for their prolactin (PRL) elevation, because the magnitude of PRL elevation can be useful in determining the etiology of hyperProlactinemia. Expand
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An update on the diagnostic and management approaches for the patient with hyperprolactinaemia and on the current data looking at the impact of high prolactin on metabolism, cardiovascular and immune systems is provided. Expand
Serum Prolactin Level to Tumor Size Ratio as a Potential Parameter for Preoperative Differentiation of Prolactinomas from Non-Functional Pituitary Adenomas
  • Jeong-Hwa Kim, K. Hur, +5 authors Doo-Sik Kong
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INTRODUCTIONPreoperative diagnosis of prolactinomas is critical because dopamine agonists have been regarded as a primary treatment modality. However, serum prolactin level alone is suboptimal forExpand
Outcomes of surgical and/or medical treatment in patients with prolactinomas during long-term follow-up: a retrospective single-centre study
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Although a surgical approach was considered for selected cases of prolactinoma, the average dose used for medical treatment was highly inadequate for the patients in the present study. Expand
Prolactinomas Resistant to Treatment With Dopamine Agonists: Long-Term Follow-Up of Six Cases
TLDR
This study confirms that tumors resistant to dopamine agonists are more aggressive, since it did not have any microadenoma; treatment with high dose of cabergoline may reduce the size of the tumor without its disappearance, and that normalization of prolactin concentration rarely occurs. Expand
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The aim of this article is to outline the potential causes of a sellar and parasellar mass, with an emphasis on the presenting clinical features and screening investigations that are applicable to doctors working in the primary care setting. Expand
Giant cabergoline-resistant prolactinoma in a man who presented with a psychotic episode during treatment: a case report
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Combined use of cabergoline with quetiapine and mirtazapine to treat a psychotic crisis may have contributed to shrinking the tumor in the patient because these antipsychotics have action mediated by growth factors that interfere with growth of pituitary tumors. Expand
Hypeprolactinemia: still an insidious diagnosis
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Endogenous antibodies include heterophile, human anti-animal, autoimmune and other nonspecific antibodies, and rheumatoid factors, that have structural similarities and can cross-react with the antibodies employed by the immunoassay, causing hyperprolactinemia misdiagnosis. Expand
Aetiologies of Hyperprolactinaemia
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The prolactin level varied between the different aetiologies and a level of >250 ng/mL was suggestive of macro-prolactinoma, which is a significant proportion of patients with hyperProlactinaemia have transient hyperprolACTinaemia. Expand
Aggressive and Malignant Prolactinomas
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A comprehensive, multidisciplinary review of the most relevant epidemiological, clinical, pathological, genetic, biochemical, and molecular aspects of aggressive and malignant prolactinomas is presented. Expand
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The definition of the etiology of hyperprolactinemia often represents a great challenge and an accurate diagnosis is paramount before treatment, and physicians should be aware that pituitary incidentalomas are found in at least 10% of adult population. Expand
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It has been suggested that laboratories should take the initiative and test for macroprolactin in all cases with elevated total serum PRL, and manufacturers should design assays for PRL which do not react or have minimal reactivity with macroproLactin. Expand
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The importance of macroprolactinemia in the differential diagnosis of hyperprolactinemic patients.
OBJECTIVE Hypersecretion of prolactin (PRL) by lactotroph cells of the anterior pituitary may lead to hyperprolactinemia in physiological or pathological conditions. However, some of the patients mayExpand
Diagnosis and management of hyperprolactinemia: Results of a Brazilian multicenter study with 1234 patients
TLDR
Although PRL levels could not reliably define the etiology of hyperprolactinemia, PRL values >500 ng/ml were exclusively seen in patients with prolactinomas, and CAB was significantly more effective than BCR in terms of Prolactin normalization, tumor shrinkage, and tolerability. Expand
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TLDR
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TLDR
Cabergoline treatment was equally effective in patients with gPRLoma and those with macroprolactinomas in regard of achieving treatment goals, although the median CBG dose was slightly higher in the g PRLoma group (2 vs. 1.5 mg/w). Expand
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TLDR
The predominance of macroprolactin, associated with normal levels of monomeric PRL, may lead to the laboratorial diagnosis of hyperprolACTinemia in subjects with no symptoms, ending up in unnecessary treatment approaches. Expand
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