TY - JOUR
AB - 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.
AD - Department of Endocrinology, ‘I. Hatieganu’ University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
Department of Dermatology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
Department of Obstetrics and Gynecology, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
Department of Endocrinology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
Department of Urology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
AU - Valea,Ana
AU - Sandru,Florica
AU - Petca,Aida
AU - Dumitrascu,Mihai,Cristian
AU - Carsote,Mara
AU - Petca,Razvan-Cosmin
AU - Ghemigian,Adina
DA - 2022/01/01
DO - 10.3892/etm.2021.10997
IS - 1
JO - Exp Ther Med
KW - prolactinoma
aggressive prolactinoma
pituitary carcinoma
aggressive pituitary tumor
cabergoline
temozolomide
hypophysectomy
prolactin
menses
menstrual cycle
PY - 2022
SN - 1792-0981
1792-1015
SP - 74
ST - Aggressive prolactinoma (Review)
T2 - Experimental and Therapeutic Medicine
TI - Aggressive prolactinoma (Review)
UR - https://doi.org/10.3892/etm.2021.10997
VL - 23
ER -