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

Archives of Endocrinology and Metabolism
Lucio VilarMarcello D Bronstein

Abstract

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 ng/mL. However, exceptions to these rules are not rare. On the other hand, among patients with macroprolactinomas (MACs), artificially low PRL levels may result from the so-called "hook effect". Patients harboring cystic MACs may also present with a mild PRL elevation. The screening for macroprolactin is mostly indicated for asymptomatic patients and those with apparent idiopathic hyperprolactinemia. Dopamine agonists (DAs) are the treatment of choice for prolactinomas, particularly cabergoline, which is more effective and better tolerated than bromocriptine. After 2 years of successful treatment, DA withdrawal should be considered in all cases of microprolactinomas and in selected cases of MACs. In this publication, the goal of the Neuroe...Continue Reading

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Citations

Jul 19, 2018·Toxicology Mechanisms and Methods·Saba KhanamYasir Hasan Siddique
Jan 28, 2020·Reviews in Endocrine & Metabolic Disorders·Júlia Vieira Oberger Marques, Cesar Luiz Boguszewski
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Sep 16, 2020·The Journal of Clinical Endocrinology and Metabolism·Camille Hage, Roberto Salvatori
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Dec 1, 2021·Endocrine·Camille Hage, Roberto Salvatori

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