Aggressive prolactinoma (Review)

  • Authors:
    • Ana Valea
    • Florica Sandru
    • Aida Petca
    • Mihai Cristian Dumitrascu
    • Mara Carsote
    • Razvan-Cosmin Petca
    • Adina Ghemigian
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  • Published online on: November 24, 2021     https://doi.org/10.3892/etm.2021.10997
  • Article Number: 74
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Abstract

Aggressive prolactinoma (APRL) is a subgroup of aggressive pituitary tumors (accounting for 10% of all hypophyseal neoplasia) which are defined by: invasion based on radiological and/or histological features, a higher proliferation profile when compared to typical adenomas and rapidly developing resistance to standard medication/protocols in addition to an increased risk of early recurrence. This is a narrative review focusing on APRL in terms of both presentation and management. Upon admission, the suggestive features may include increased serum prolactin with a large tumor diameter (mainly >4 cm), male sex, early age at diagnosis (<20 years), and genetic predisposition [multiple endocrine neoplasia type 1 (MEN1), aryl hydrocarbon receptor interacting protein (AIP), succinate dehydrogenase (SDHx) gene mutations]. Potential prognostic factors are indicated by assessment of E-cadherin, matrix metalloproteinase (MMP)-9, and vascular endothelial growth factor (VEGF) status. Furthermore, during management, APRL may be associated with dopamine agonist (DA) resistance (described in 10-20% of all prolactinomas), post-hypophysectomy relapse, mitotic count >2, Ki-67 proliferation index ≥3%, the need for radiotherapy, lack of response in terms of controlling prolactin levels and tumor growth despite multimodal therapy. However, none of these as an isolated element serves as a surrogate of APRL diagnosis. A fourth-line therapy is necessary with temozolomide, an oral alkylating chemotherapeutic agent, that may induce tumor reduction and serum prolactin reduction in 75% of cases but only 8% have a normalization of prolactin levels. Controversies surrounding the duration of therapy still exist; also regarding the fifth-line therapy, post-temozolomide intervention. Recent data suggest alternatives such as somatostatin analogues (pasireotide), checkpoint inhibitors (ipilimumab, nivolumab), tyrosine kinase inhibitors (TKIs) (lapatinib), and mTOR inhibitors (everolimus). APRL represents a complex condition that is still challenging, and multimodal therapy is essential.
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January-2022
Volume 23 Issue 1

Print ISSN: 1792-0981
Online ISSN:1792-1015

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Spandidos Publications style
Valea A, Sandru F, Petca A, Dumitrascu MC, Carsote M, Petca R and Ghemigian A: Aggressive prolactinoma (Review). Exp Ther Med 23: 74, 2022
APA
Valea, A., Sandru, F., Petca, A., Dumitrascu, M.C., Carsote, M., Petca, R., & Ghemigian, A. (2022). Aggressive prolactinoma (Review). Experimental and Therapeutic Medicine, 23, 74. https://doi.org/10.3892/etm.2021.10997
MLA
Valea, A., Sandru, F., Petca, A., Dumitrascu, M. C., Carsote, M., Petca, R., Ghemigian, A."Aggressive prolactinoma (Review)". Experimental and Therapeutic Medicine 23.1 (2022): 74.
Chicago
Valea, A., Sandru, F., Petca, A., Dumitrascu, M. C., Carsote, M., Petca, R., Ghemigian, A."Aggressive prolactinoma (Review)". Experimental and Therapeutic Medicine 23, no. 1 (2022): 74. https://doi.org/10.3892/etm.2021.10997