Prolactinoma


Article Author:
Rajini Kanth Yatavelli


Article Editor:
Kamal Bhusal


Editors In Chief:
Melissa Max
Danyae Lee
Manouchkathe Cassagnol


Managing Editors:
Orawan Chaigasame
Carrie Smith
Abdul Waheed
Frank Smeeks
Kristina Soman-Faulkner
Benjamin Eovaldi
Radia Jamil
Sobhan Daneshfar
Saad Nazir
William Gossman
Pritesh Sheth
Hassam Zulfiqar
Navid Mahabadi
Steve Bhimji
John Shell
Matthew Varacallo
Ahmad Malik
Mark Pellegrini
James Hughes
Beata Beatty
Hajira Basit
Phillip Hynes


Updated:
11/18/2018 8:37:43 PM

Introduction

Prolactin-secreting tumors of the pituitary gland are called prolactinomas. It is the most common secretory tumors of the pituitary gland accounting for up to 40% of total pituitary adenomas. Prolactinomas cause a wide variety of symptoms either due to mass effect of the tumor or due to hypersecretion of prolactin. Based on the size of the tumors, prolactinomas can be classified as micro prolactinoma (smaller than 10 mm), macroprolactinoma (larger than 10 mm) or giant prolactinoma (larger than 4 cm). Hyperprolactinemia is not always due to prolactinoma and other causes like pregnancy, drugs, hypothyroidism, and pituitary stalk effect due to other pituitary tumors should be considered in the differential. [1][2]

Etiology

The exact cause of prolactinoma is poorly understood. Prolactinomas arise from monoclonal expansion of pituitary lactotrophs which have undergone somatic mutation. Pituitary tumor transforming gene (PTTG) overexpression and mutation of a receptor of fibroblast growth factor 4 (FGF4) have been found in pituitary adenoma mainly prolactinoma. Most prolactinomas are sporadic in origin but can also occur as part of familial syndromes. Familial isolated prolactinoma and other pituitary adenomas have been described. It can be a part of multiple endocrine neoplasia type 1 (MEN1), up to 15% to 60% of MEN1 can have a pituitary adenoma, and the majority of them are prolactinomas.[3][4]

Epidemiology

Prolactinomas account for up to 40% of all clinically recognized pituitary adenomas. Mean prevalence of prolactinoma is estimated to be approximately 10 per 100,000 in men and 30 per 100,000 in women, with a peak prevalence in women aged 25 to 34 years. Macroprolactinoma is diagnosed more commonly in a female with a female to male ratio of 1:20; whereas, macroprolactinoma is equally common in both genders.[5][6]

Pathophysiology

Prolactinomas arise from monoclonal expansion of pituitary lactotrophs and are mostly benign, often sharply demarcated without evidence of invasion. A few prolactinomas could behave aggressively with the invasion of surrounding local structures, and they generally have higher mitotic activity and are more cellular and pleomorphic. Distance extracranial involvement is required to be called as a malignant prolactinoma. Lateral parts of anterior pituitary are most common sites involved with prolactinoma.[7]

Rarely mixed tumors which secrete growth hormone and prolactin, adrenocorticotropic hormone (ACTH) and prolactin or thyroid stimulating hormone (TSH) and prolactin can also be seen which is recognized with immunohistochemistry. 

Microadenomas (smaller than 1 cm) usually are confined to sella turcica and do not cause any compressive symptoms, but macroadenomas (greater than 1 cm) can expand to an adjacent structure like optic chiasm, cavernous sinuses and causes various compressive symptoms like visual field defects, cranial nerve palsy, and headaches. Symptoms of microadenoma are mainly due to elevated levels of prolactin.

Prolactin levels are usually directly proportionate to the size of tumor ranging from below 200 ng/ml with less than 1 cm, 200 ng/ml to 1000 ng/ml with 1 cm to 2 cm and more than 1000 ng/ml with tumor sized more than 2 cm in diameter. If prolactin level does not match with tumor size, then it can be either due to not well-differentiated prolactinoma or presence of a large cystic component in the tumor.

Hypothalamus has a predominant inhibitory influence on prolactin secretion via dopamine and any factor which disrupts this mechanism causes hyperprolactinemia. It is important to consider the various causes of hyperprolactinemia as increased prolactin secretion is noted in many physiological and pathological states other than prolactinomas.

History and Physical

Prolactinomas clinically present because of the mass effect of the tumor or because of hyperprolactinemia. Microprolactinomas (less than 1 cm) can present with symptoms of hyperprolactinemia or are detected incidentally on neuroimaging done for other reasons. Macroprolactinomas on the other hand present with mass effects on the surrounding structures.

Signs and symptoms due to mass effect

  1. Headaches
  2. Vision Changes-visual field deficits, blurred vision, decreased visual acuity
  3. Cranial nerve palsies-especially with invasive tumors or with pituitary apoplexy
  4. Seizures, Hydrocephalus, Unilateral exophthalmos are rare presentations
  5. Pituitary apoplexy is a medical emergency because of spontaneous hemorrhage into the pituitary tumor and presents with severe headaches, vision changes, and panhypopituitarism.

Signs and symptoms due to Hyperprolactinemia

Males

  1. Decreased libido
  2. Impotence
  3. Erectile dysfunction
  4. Oilgozoospermia (due to secondary hypogonadism)

Females

  1. Oligomenorrhea, amenorrhea
  2. Infertility, loss of libido
  3. Galactorrhea

Children and Adolescents

  1. Growth arrest
  2. Pubertal delay
  3. Primary amenorrhea

Other features like osteopenia, anxiety, depression, fatigue, emotional instability can be seen in both sexes. About 10% of prolactinomas can be co-secreting growth hormone so gigantism/acromegaly can be seen in those patients.

Evaluation

An extensive history and physical examination are needed to exclude other causes of hyperprolactinemia and to document any visual field deficits, galactorrhea, growth changes, hypopituitarism, menstrual irregularities, impotence, infertility. Formal visual field testing by an ophthalmologist should be done especially for macroadenomas. [8][9][10] The following differential diagnosis should be considered during evaluation:

Physiological causes:

  • Pregnancy
  • Nipple stimulation in lactating women
  • Stress

Pathological causes:

  •  Hypothalamic disorders
  1.  Craniopharyngiomas, meningioma, dysgerminoma
  2.  Non-secreting pituitary adenoma
  3.  Sarcoidosis; Histiocytosis X
  4.  Cranial irradiation
  •  Pituitary disorders
  1. Prolactinoma
  2. Acromegaly/Cushing disease
  3. Empty Sella syndrome
  4.  Lymphocytic hypophysitis 
  • Drugs (Dopamine antagonists)
  1. Antipsychotics
  2. Tricyclic antidepressants; SSRI
  3. Antiemetic: Metoclopramide, domperidone, prochlorperazine
  4. Antihypertensive: Verapamil, alpha-methyldopa  
  5. Opioid analgesics: Morphine, methadone, 
  6. Hypothyroidism
  7. Idiopathic hyperprolactinemia

Treatment / Management

Laboratory

The test begins with serum prolactin level. If prolactin level is high, comprehensive metabolic panel, TSH and a pregnancy test (for women of childbearing age) should be obtained. Assessment of other pituitary hormones including cortisol, ACTH, IGF-1, LH, FSH and testosterone/estradiol should be done based on age and gender to exclude any hypopituitarism or other co-secreting tumors.[11][12][13]

Patients can have very high prolactin levels; however, when measured they can be reported as falsely low due to a phenomenon called “Hook effect.” When there is a suspicion, serial dilution of the serum sample and re-measuring the prolactin levels will be helpful.

Another condition where measured prolactin can be high although true prolactin level is low is when patients have higher molecular weight prolactin called macroprolactin. Macroprolactin levels should be obtained in asymptomatic hyperprolactinemia. The laboratory can pretreat the serum with polyethylene glycol to precipitate the macroprolactin before the immunoassay for prolactin.

Imaging

CT scan may demonstrate the mass, but MRI with gadolinium is the preferred imaging modality for evaluation of hyperprolactinemia as it best describes the anatomy of the hypothalamic-pituitary area. All patients with tumors adjacent to or compressing to optic chiasm should be referred for formal visual field testing.

Treatment/Management

Macroprolactinomas incidentally discovered without symptoms can be observed with periodic monitoring of the labs and imaging.[14][15]

Macroprolactinoma or symptomatic microadenoma should be treated with dopamine agonist therapy. Goals of treatment would be tumor shrinkage, restoration of visual fields if any defect, reversal of galactorrhea and restoration of fertility or abnormal sexual function. Cabergoline is preferred due to a higher frequency in normalizing prolactin level and tumor shrinkage. Amenorrhea caused by macroprolactinoma can be treated with oral contraceptive if fertility is not desired without dopamine agonists.

Most prolactinomas are managed with medical therapy only with surgery and radiotherapy reserved for refractory cases.

Medical Therapy

Unlike other pituitary tumors, the preferred treatment for prolactinomas is medical therapy. Oral contraceptive alone can be given if only symptoms are amenorrhea and or osteoporosis. Specific treatment for prolactinomas is one of the dopamine agonists.

Cabergoline and bromocriptine are two commonly used dopamine agonists. Pergolide is withdrawn from the market due to concerns about valvular heart disease, and quinagolide is not available in the United States. Dopamine agonists suppress the synthesis and release of prolactin and lactotroph cellular proliferation causing shrinkage of the tumor. They can cause nausea and dizziness.

Bromocriptine is preferred during pregnancy if needed due to more available data than cabergoline. It is also cheaper but has more side effects than cabergoline like nausea, vomiting, nasal stuffiness, postural hypotension. It is started as 1.25 mg at bedtime or after dinner daily for one week then increased to 1.25 mg 2 times a day (after breakfast and dinner). The dose should be increased every 4 weeks if prolactin level is not normalized up to a maximum dose of 5 mg two times a day.  If bromocriptine is unsuccessful, cabergoline should be started.

Treatment with dopamine agonist should be tapered and stopped if prolactin level is normal and the tumor is not visible in MRI after at least two years of treatment.

Estrogen replacement is an option in a woman with inadequate response to treatment and not desiring fertility. For a man with inadequate treatment response, testosterone therapy (if no fertility desired) or human chorionic gonadotropin (if fertility desired) should be started.

Surgery

Transsphenoidal surgery is preferred surgical option if surgery is indicated for following reasons:

  • Unsuccessful medical therapy to lower prolactin level and decrease tumor size after several months of maximum dose.
  • A woman with large prolactinoma (more than 3 cm) and wishes to become pregnant as it can get larger during pregnancy.
  • Radiation therapy should be considered for residual tumor after surgery and resistant to cabergoline therapy.

Differential Diagnosis

  • Pregnancy
  • Hypothyroidism
  • Renal failure
  • Breast stimulation
  • Pituitary tumors

Complications

  • Mass effect leading to visual deficits, cranial nerve palsies or pituitary apoplexy
  • Infertility
  • Osteoporosis
  • Complications related to surgery may include vision loss, CSF leak, permanent hypopituitarism
  • Seizures

Consultations

  • Neurosurgeon
  • Radiation oncologist
  • Endocrinologist

Pearls and Other Issues

Usually, in pregnancy, there is hyperplasia of pituitary lactotrophs and prolactin levels increase. Prolactinomas increase in size during pregnancy and in patients with known macroadenomas one can consider surgery before pregnancy or those on medical therapy should be monitored carefully with periodic visual field testing. Bromocriptine has the largest safety database in pregnancy and is preferred drug during pregnancy.

Pituitary apoplexy is an endocrine emergency when there is spontaneous hemorrhage into the pituitary adenoma/prolactinoma and patients present with sudden onset headaches, vision changes. Any patient with known prolactinoma/pituitary adenoma presenting with above symptoms would need an urgent MRI and neurosurgical/endocrine evaluation.

Enhancing Healthcare Team Outcomes

Once a prolactinoma has been diagnosed, patient education is key to prevent the high morbidity. All patients must be closely followed and patients must be educated about the symptoms of a prolactinoma and when to seek help. If the decision is made to taper or withdraw medical therapy, the patient must undergo imaging studies periodically to monitor for recurrence of growth. The pharmacist should educate the patient on drugs used to treat prolactinomas and their adverse effects. Finally, the oncology nurse should educate the patient on the possibility of radiation therapy for large lesions and the possibility of hypopituitarism.[16][17] (Level V)

Outcomes

The majority of patients with microprolactinomas have an excellent prognosis. These patients can be managed medically for extended periods. Macroprolactinomas, on the other hand, can grow over time and require more aggressive treatment. The growth rate of macroprolactinomas is unpredictable, and the patient must be closely followed up. The decision to taper medical therapy requires sound judgment because the tumor can grow in size, without treatment. [18](Level V)


Interested in Participating?

We are looking for contributors to author, edit, and peer review our vast library of review articles and multiple choice questions. In as little as 2-3 hours you can make a significant contribution to your specialty. In return for a small amount of your time, you will receive free access to all content and you will be published as an author or editor in eBooks, apps, online CME/CE activities, and an online Learning Management System for students, teachers, and program directors that allows access to review materials in over 500 specialties.

Improve Content - Become an Author or Editor

This is an academic project designed to provide inexpensive peer-reviewed Apps, eBooks, and very soon an online CME/CE system to help students identify weaknesses and improve knowledge. We would like you to consider being an author or editor. Please click here to learn more. Thank you for you for your interest, the StatPearls Publishing Editorial Team.

Prolactinoma - Questions

Take a quiz of the questions on this article.

Take Quiz
What is the most common presentation of a prolactinoma in men?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 17-year-old female presents with secondary amenorrhea with onset six months ago. She is not sexually active and has no significant past medical history. She reports that she did a pregnancy test anyway, and it was negative. She reports bilateral clear discharge from both breasts. The exam is normal except for the galactorrhea. Which of the following tests is most likely to provide the diagnosis?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 23-year-old patient presents with secondary amenorrhea and galactorrhea. Exam is only remarkable for clear discharge from both nipples. Laboratory results show thyroid stimulating hormone 3.4 IU/mL (0.27-4.20), beta-hCG undetectable, and prolactin 175 ng/mL (3.4-24.1). What is the next step in the management of this patient?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following is not an indication for transsphenoidal pituitary surgery in a patient with a prolactinoma?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 27-year-old female has been successfully treated with cabergoline for a prolactinoma. The 1.2 cm adenoma has reduced in size, the galactorrhea has resolved, and menses has resumed. How long should the medication be continued?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 45-year old female has a pituitary mass. What hormone is most commonly secreted by this mass?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
What is the best treatment for a microadenoma secreting excess prolactin?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 29-year-old previously healthy female reports that she had not had a menstrual cycle for the past 4 months. She is on no medications and does not feel pregnant. She has noticed milk production from both breasts and constant headaches. She now claims that her vision is blurred. What is the first test to investigate this patient?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A female notices discharge from her nipples and amenorrhea. The pregnancy test is negative. Her exam otherwise is normal except suggestion of a possible slight left temporal quadrantanopsia. What is the most likely diagnosis?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Select the treatment of choice for prolactinomas during pregnancy.



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
What is the most frequent secreting adenoma of the pituitary?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Prolactinomas during pregnancy should be treated by which of the following?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A patient has amenorrhea for 4 months, galactorrhea, and blurry vision. Prolactin level is 130 ng/ml (5 to 20 ng/ml) and MRI shows an 11-mm macroadenoma. Select the appropriate next step.



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 27-year-old nulliparous female presents with galactorrhea for 4 months and irregular menses for 8 months. Urine HCG is negative and serum estradiol and LH are low. Select the most probable diagnosis.



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A male with a prolactinoma is least likely to exhibit which of the following?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
What is the best pharmacological treatment for a small prolactinoma?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 44-year-old male truck driver consulted his optometrist because of headaches and visual field defects. He thought he needed new glasses. The optometrist referred him to a physician. A CT scan of the head showed a 2.5 cm mass in the sella turcica. Which of the following is true with regards to his condition?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 33-year old postpartum female presents 6 weeks after delivery with complaints of a headache and blurry vision. She complains that even though she never breastfed she has had milk production that is profuse. Her menstrual cycle has not returned, and she is worried that something is not right. The physical exam is unremarkable. Bloodwork reveals elevated prolactin levels. MRI T1 weighted images reveal a 9 mm lesion that is isodense at the base of the pituitary gland. What is the best management of this patient?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 42-year-old woman presents to the emergency room after being involved in a motor vehicle accident where she ran into another vehicle traveling in the next lane. Patient denies seeing the other vehicle next to her. Visual fields examination via confrontation shows vision loss in the outer visual fields of both left and right eye. MRI of the brain shows a lesion in the sella turcica. Which of the following is the most common associated finding in this patient?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up

Prolactinoma - References

References

Pekic S,Soldatovic I,Miljic D,Stojanovic M,Doknic M,Petakov M,Popovic V, Familial Cancer Clustering in Patients with Prolactinoma. Hormones     [PubMed]
Cooper O,Greenman Y, Dopamine Agonists for Pituitary Adenomas. Frontiers in endocrinology. 2018     [PubMed]
Araújo C,Marques O,Almeida R,Santos MJ, Macroprolactinomas: longitudinal assessment of biochemical and imaging therapeutic responses. Endocrine. 2018 Aug 7     [PubMed]
Atluri S,Sarathi V,Goel A,Boppana R,Shivaprasad C, Etiological Profile of Galactorrhoea. Indian journal of endocrinology and metabolism. 2018 Jul-Aug     [PubMed]
Breil T,Lorz C,Choukair D,Mittnacht J,Inta I,Klose D,Jesser J,Schulze E,Bettendorf M, Clinical Features and Response to Treatment of Prolactinomas in Children and Adolescents: A Retrospective Single-Centre Analysis and Review of the Literature. Hormone research in paediatrics. 2018     [PubMed]
Hoffmann A,Adelmann S,Lohle K,Claviez A,Müller HL, Pediatric prolactinoma: initial presentation, treatment, and long-term prognosis. European journal of pediatrics. 2018 Jan     [PubMed]
Saleem M,Martin H,Coates P, Prolactin Biology and Laboratory Measurement: An Update on Physiology and Current Analytical Issues. The Clinical biochemist. Reviews. 2018 Feb     [PubMed]
Maldaner N,Serra C,Tschopp O,Schmid C,Bozinov O,Regli L, [Modern Management of Pituitary Adenomas - Current State of Diagnosis, Treatment and Follow-Up]. Praxis. 2018 Jul     [PubMed]
Bettencourt-Silva R,Pereira J,Belo S,Magalhães D,Queirós J,Carvalho D, Prolactin-Producing Pituitary Carcinoma, Hypopituitarism, and Graves' Disease-Report of a Challenging Case and Literature Review. Frontiers in endocrinology. 2018     [PubMed]
Krajewski KL,Rotermund R,Flitsch J, Pituitary adenomas in children and young adults. Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery. 2018 Sep     [PubMed]
Vilar L,Abucham J,Albuquerque JL,Araujo LA,Azevedo MF,Boguszewski CL,Casulari LA,Cunha Neto MBC,Czepielewski MA,Duarte FHG,Faria MDS,Gadelha MR,Garmes HM,Glezer A,Gurgel MH,Jallad RS,Martins M,Miranda PAC,Montenegro RM,Musolino NRC,Naves LA,Ribeiro-Oliveira Júnior A,Silva CMS,Viecceli C,Bronstein MD, Controversial issues in the management of hyperprolactinemia and prolactinomas - An overview by the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism. Archives of endocrinology and metabolism. 2018 Mar-Apr     [PubMed]
Nakhleh A,Shehadeh N,Hochberg I,Zloczower M,Zolotov S,Taher R,Daoud Naccache D, Management of cystic prolactinomas: a review. Pituitary. 2018 Aug     [PubMed]
Beshyah SA,Sherif IH,Chentli F,Hamrahian A,Khalil AB,Raef H,El-Fikki M,Jambart S, Management of prolactinomas: a survey of physicians from the Middle East and North Africa. Pituitary. 2017 Apr     [PubMed]
Maiter D, Current Challenges in the Management of Prolactinomas. European endocrinology. 2015 Apr     [PubMed]
Salazar-López-Ortiz CG,Hernández-Bueno JA,González-Bárcena D,López-Gamboa M,Ortiz-Plata A,Porias-Cuéllar HL,Rembao-Bojórquez JD,Sandoval-Huerta GA,Tapia-Serrano R,Vázquez-Castillo GG,Vital-Reyes VS, [Clinical practice guideline for the diagnosis and treatment of hyperprolactinemia]. Ginecologia y obstetricia de Mexico. 2014 Feb     [PubMed]
Langlois F,McCartney S,Fleseriu M, Recent Progress in the Medical Therapy of Pituitary Tumors. Endocrinology and metabolism (Seoul, Korea). 2017 Jun     [PubMed]
Cuny T,Barlier A,Feelders R,Weryha G,Hofland LJ,Ferone D,Gatto F, Medical therapies in pituitary adenomas: Current rationale for the use and future perspectives. Annales d'endocrinologie. 2015 Feb     [PubMed]
Rutkowski MJ,Aghi MK, Medical versus surgical treatment of prolactinomas: an analysis of treatment outcomes. Expert review of endocrinology     [PubMed]

Disclaimer

The intent of StatPearls is to provide practice questions and explanations to assist you in identifying and resolving knowledge deficits. These questions and explanations are not intended to be a source of the knowledge base of all of medicine, nor is it intended to be a board or certification review of Pharmacy-Pharmacotherapy. The authors or editors do not warrant the information is complete or accurate. The reader is encouraged to verify each answer and explanation in several references. All drug indications and dosages should be verified before administration.

StatPearls offers the most comprehensive database of free multiple-choice questions with explanations and short review chapters ever developed. This system helps physicians, medical students, dentists, nurses, pharmacists, and allied health professionals identify education deficits and learn new concepts. StatPearls is not a board or certification review system for Pharmacy-Pharmacotherapy, it is a learning system that you can use to help improve your knowledge base of medicine for life-long learning. StatPearls will help you identify your weaknesses so that when you are ready to study for a board or certification exam in Pharmacy-Pharmacotherapy, you will already be prepared.

Our content is updated continuously through a multi-step peer review process that will help you be prepared and review for a thorough knowledge of Pharmacy-Pharmacotherapy. When it is time for the Pharmacy-Pharmacotherapy board and certification exam, you will already be ready. Besides online study quizzes, we also publish our peer-reviewed content in eBooks and mobile Apps. We also offer inexpensive CME/CE, so our content can be used to attain education credits while you study Pharmacy-Pharmacotherapy.