Hyperprolactinemia/Prolactinomas in the Postmenopausal Period: Challenges in Diagnosis and Management

  title={Hyperprolactinemia/Prolactinomas in the Postmenopausal Period: Challenges in Diagnosis and Management},
  author={Sandra Pekic and Milica Medi{\'c} Stojanoska and V. P. Popovi{\'c}},
  pages={28 - 33}
Hyperprolactinemia is not a common finding in postmenopausal women. Prolactinomas detected after menopause are usually macroadenomas. Due to atypical clinical features they may remain unrecognized for a long period of time. Interestingly the growth potential of prolactinomas remains after menopause. Most tumors are invasive and present with high prolactin levels. They respond to medical treatment with dopamine agonists in terms of prolactin normalization, tumor shrinkage, and improvement in… 
8 Citations
Hyperprolactinemia in the postmenopause: versions and contraversions
The prevalence of hyperprolactinemia in postmenopausal women is unknown and has been estimated as infrequent by many studies. Prolactinomas found after menopause are usually macroadenomas and remain
High biochemical recurrence rate after withdrawal of cabergoline in prolactinomas: is it necessary to restart treatment?
Biochemical recurrence in prolactinomas is very frequent, however, in only a few of these patients reinitiation of DA is necessary, and the necessity to restart treatment is necessary.
The epidemiology, diagnosis and treatment of Prolactinomas:The old and the new.
  • P. Chanson, D. Maiter
  • Medicine
    Best practice & research. Clinical endocrinology & metabolism
  • 2019
DAs still represent the primary therapy for most prolactinomas, but neurosurgery has regained interest, due to progress in surgical techniques and a high success rate in microprolactinoma, as well as to some underestimated side effects of long-term DA treatment, such as impulse control disorders or impaired quality of life.
Persistent bone impairment despite long-term control of hyperprolactinemia and hypogonadism in men and women with prolactinomas
It was found that persistent hyperprolactinemia and male sex were independent risk factors for long-term bone impairment and bone impairment as “end organ” reflects the full range of the disease and could become a surrogate marker for the severity of long-lasting hyper Prolactinoma and associated hypogonadism.
Pituitary Hyperplasia, Hormonal Changes and Prolactinoma Development in Males Exposed to Estrogens—An Insight From Translational Studies
The mechanisms of estrogen action upon their application in male animal models and the putative role of the thyroid and/or glucocorticoid hormones in prolactinoma development are analyzed, based on the current scarce literature.
Glucose Abnormalities Associated to Prolactin Secreting Pituitary Adenomas
In patients with PRL-secreting pituitary adenomas control of PRL excess by dopamine agonists is mandatory to improve glucose and insulin abnormalities.
Update on vertebral fractures in pituitary diseases: from research to clinical practice
This review is an update on skeletal fragility in patients with pituitary diseases, with a focus on clinical and therapeutic aspects concerning the management of VFs.
Manejo terapêutico da hiperprolactinemia: uma revisão de literatura
Introdução: A prolactina (PRL) é um hormônio sintetizado e secretado pelas células lactotróficas da adeno-hipófise, tendo como principal função o estímulo à lactação. A hiperprolactinemia é definida


The treatment of hyperprolactinemia in postmenopausal women with prolactin-secreting microadenomas: Cons
There is no clinical evidence that normalization of prolactin levels in postmenopausal women improves areal bone mineral density or reduces fracture risk, and treatment with low doses of exogenous estrogen appears to be safe in patients with hyperprolactinemia and is rarely associated with tumor enlargement.
Treatment of hyperprolactinemia in post-menopausal women: pros
Dopamine agonists appear to be as effective in these patients as in younger women to induce reduction of prolactin levels and tumour shrinkage, potentially favouring medical treatment with dopamine agonists in post-menopausal women diagnosed with hyperprolactinemia.
Women with prolactinomas presented at the postmenopausal period
Two large pituitary tumors disappeared on MRI following long-term dopamine agonist therapy, and all other treated prolactinomas, except the resistant adenoma, shrank following medical treatment.
Therapy of endocrine disease: the challenges in managing giant prolactinomas.
As in every prolactinoma, dopamine agonists are the first-line treatment allowing rapid alleviation of neurologic symptoms in the majority of the cases, a significant reduction in tumour size in three-fourths of the patients and PRL normalization in 60-70%.
The challenges in managing giant prolactinomas
Giant prolactinomas are rare tumours, representing only 2–3% of all prolactin (PRL)-secreting tumours and raising special diagnostic and therapeutic challenges. Based on several considerations
Prospective study of high-dose cabergoline treatment of prolactinomas in 150 patients.
Individualized high-dose cabergoline treatment can normalize hyperprolactinemia and hypogonadism in nearly all prolactinomas irrespective of tumor size or preceding treatments.
Misdiagnosis due to the Hook Effect in Prolactin Assay
The hook effect must be kept in mind while evaluating a giant pituitary adenoma with moderately elevated prolactin levels, this way unnecessary surgical procedures or irradiation may be avoided.
Characterization of resistance to the prolactin-lowering effects of cabergoline in macroprolactinomas: a study in 122 patients.
Most macroprolactinomas primarily treated with CAB are adequately controlled with doses < or =1.5 mg/week, and about 20% of patients, mainly men and/or those with invasive tumors will require a higher dose of CAB.
Dopaminergic tone and obesity: an insight from prolactinomas treated with bromocriptine.
The long-acting dopamine agonist BC, by increasing dopaminergic tone, may influence body weight composition in likely bodyprolinemia in patients with prolactinomas treated with the long- acting dopamine agonists bromocriptine.
The prevalence and natural history of pituitary hemorrhage in prolactinoma.
The data show that incidental hemorrhage in prolactinoma is not uncommon, and is particularly common in women with macroprolactinomas, where 1 in 5 develop hemorrhage, and the majority are asymptomatic and resolve spontaneously.