Abstract
Prolactinomas as the most common type of functional pituitary adenoma and most will respond to dopamine agonist (DA) therapy with normalization of prolactin levels, restoration of gonadal function and/or reduction in tumor volume. A minority of prolactinomas are refractory to conventional doses of DA and present a clinical challenge. Characteristics associated with DA resistance include male sex, certain radiologic features (large size, cavernous sinus invasion, other characteristics), histopathologic evidence of high cell proliferation, and in a small number of cases, inherited pathologic germline variants of genes associated with pituitary tumors, such as MEN1 and AIP. Clinical management often requires a multimodal approach including titration of DA to higher than usual doses, surgical resection or debulking, and targeted radiotherapy. Robust evidence is lacking for non-approved adjunct therapies, such as aromatase inhibitors and estrogen receptor modulators, although the somatostatin receptor ligand pasireotide may have potential in select patients.
TY - JOUR
T1 - Resistant prolactinomas.
A1 - Samson,Susan L,
Y1 - 2026/03/24/
PY - 2026/5/13/medline
PY - 2026/3/29/pubmed
PY - 2026/3/28/entrez
KW - amenorrhea
KW - dopamine agonist
KW - galactorrhea
KW - hyperprolactinemia
KW - pituitary adenoma
KW - prolactinoma
KW - resistance
KW - transsphenoidal surgery
SP - 102100
EP - 102100
JF - Best practice & research. Clinical endocrinology & metabolism
JO - Best Pract Res Clin Endocrinol Metab
VL - 40
IS - 2
N2 - Prolactinomas as the most common type of functional pituitary adenoma and most will respond to dopamine agonist (DA) therapy with normalization of prolactin levels, restoration of gonadal function and/or reduction in tumor volume. A minority of prolactinomas are refractory to conventional doses of DA and present a clinical challenge. Characteristics associated with DA resistance include male sex, certain radiologic features (large size, cavernous sinus invasion, other characteristics), histopathologic evidence of high cell proliferation, and in a small number of cases, inherited pathologic germline variants of genes associated with pituitary tumors, such as MEN1 and AIP. Clinical management often requires a multimodal approach including titration of DA to higher than usual doses, surgical resection or debulking, and targeted radiotherapy. Robust evidence is lacking for non-approved adjunct therapies, such as aromatase inhibitors and estrogen receptor modulators, although the somatostatin receptor ligand pasireotide may have potential in select patients.
SN - 1878-1594
UR - https://www.unboundmedicine.com/prime/citation/41904067/Resistant_prolactinomas.
DB - PRIME
DP - Unbound Medicine
ER -
