Elucidating Clinical Queries for Tailored Therapy in Patients with Prolactinoma

Abstract

Prolactinomas are the most prevalent type of pituitary neuroendocrine adenomas, primarily affecting women of reproductive age. Unlike other pituitary tumors, the first-line management has traditionally been pharmacological rather than surgical. This preference is due to the effectiveness of dopamine agonists (DAs), which typically reduce tumor size and normalize prolactin levels in most patients. However, this does not imply that there is no room for improvement; the duration of treatment and medication side effects often lead to compliance issues among patients. Recent advances in surgical techniques and molecular biology have paved the way for the development of precision medicine, allowing for more flexible and personalized treatment strategies for prolactinomas. This review aims to enhance clinical decision-making and patient care for endocrinologists by focusing on several key factors: predictive markers of DA sensitivity, clinical characteristics and suitability for transsphenoidal adenomectomy as a potential first-line treatment, factors determining the successful withdrawal of DAs after prolonged use, safety concerns during pre/post-pregnancy and breastfeeding, and determinants of tumor aggressiveness. Through tailored therapy-a patient-focused, multidisciplinary approach- we aim to improve the management of prolactinoma patients.

Keywords: Clinical decision-making; Precision medicine; Prolactinoma.

Fig. 1.

Presentative biomarkers of sensitivity to dopamine agonists in patients with prolactinomas. DA, dopamine agonist; PRL, prolactin; CS, cavernous sinus; D2R, dopamine 2 receptor; GRK2, G protein-coupled receptor kinase 2; ERα, estrogen receptor alpha; TSA, transsphenoidal adenomectomy; PTTG, pituitary tumor-transforming gene.