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Article Dans Une Revue Expert Review of Endocrinology and Metabolism Année : 2019

Clinical management of difficult to treat macroprolactinomas

Résumé

Introduction: Prolactinomas represent the most common pituitary adenomas encountered in the clinic. While a majority of these tumors will be successfully treated by dopamine agonist (DA) such as cabergoline, their management becomes problematic since a resistance to DA can occur and/or if the tumor displays features of aggressiveness, two conditions that are closely related. Areas covered: Epidemiology and medical treatment of prolactinomas; resistance to DA and molecular basis of DA-resistance; therapeutical alternatives in case of DA-resistant Prolactinomas and therapies in development; summarizing conclusions. Expert opinion: The management of DA-resistant prolactinomas requires a multidisciplinary approach by an expert team. Along with discussions about surgery with or without gamma knife radiosurgery, genetic screening for multiple endocrine neoplasia type 1 (MEN1) syndrome is actively discussed in a case-by-case approach. In case of surgery, a careful analysis of the tumor sample can provide information about its aggressivity potential according to recent criteria. Ultimately, temozolomide can be indicated if the tumor is rapidly growing and/or threatening for the patient.
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Dates et versions

hal-02462185 , version 1 (20-02-2020)

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Nicolas Sahakian, Frederic Castinetti, Henry Dufour, Thomas Graillon, Pauline Romanet, et al.. Clinical management of difficult to treat macroprolactinomas. Expert Review of Endocrinology and Metabolism, 2019, 14 (3), pp.179-192. ⟨10.1080/17446651.2019.1596024⟩. ⟨hal-02462185⟩
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