Mary P. Gillam,
Mark E. Molitch,
Gaetano Lombardi and
Annamaria Colao
Division of Endocrinology, Metabolism, and Molecular Medicine (M.P.G., M.E.M.), Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611; and Department of Molecular and Clinical Endocrinology and Oncology (G.L., A.C.), University "Federico II" of Naples, Naples 80131, Italy
Correspondence: Address all correspondence and requests for reprints to: Annamaria Colao, M.D., Ph.D., Department of Molecular and Clinical Endocrinology and Oncology, University "Federico II" of Naples, Via Sergio Pansini 5, Naples I-80131, Italy. E-mail: colao{at}unina.it
Prolactinomas account for approximately 40% of all pituitaryadenomas and are an important cause of hypogonadism and infertility.The ultimate goal of therapy for prolactinomas is restorationor achievement of eugonadism through the normalization of hyperprolactinemiaand control of tumor mass. Medical therapy with dopamine agonistsis highly effective in the majority of cases and representsthe mainstay of therapy. Recent data indicating successful withdrawalof these agents in a subset of patients challenge the previouslyheld concept that medical therapy is a lifelong requirement.Complicated situations, such as those encountered in resistanceto dopamine agonists, pregnancy, and giant or malignant prolactinomas,may require multimodal therapy involving surgery, radiotherapy,or both. Progress in elucidating the mechanisms underlying thepathogenesis of prolactinomas may enable future developmentof novel molecular therapies for treatment-resistant cases.This review provides a critical analysis of the efficacy andsafety of the various modes of therapy available for the treatmentof patients with prolactinomas with an emphasis on challengingsituations, a discussion of the data regarding withdrawal ofmedical therapy, and a foreshadowing of novel approaches totherapy that may become available in the future.
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