Controversial issues in the management of hyperprolactinemia and prolactinomas : an overview by the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism
Autor(a) principal: | |
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Data de Publicação: | 2018 |
Outros Autores: | , , , , , , , , , , , , , , , , , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UnB |
Texto Completo: | http://repositorio.unb.br/handle/10482/33729 http://dx.doi.org/10.20945/2359-3997000000032 |
Resumo: | Prolactinomas are the most common pituitary adenomas (approximately 40% of cases), and they represent an important cause of hypogonadism and infertility in both sexes. The magnitude of prolactin (PRL) elevation can be useful in determining the etiology of hyperprolactinemia. Indeed, PRL levels > 250 ng/mL are highly suggestive of the presence of a prolactinoma. In contrast, most patients with stalk dysfunction, drug-induced hyperprolactinemia or systemic diseases present with PRL levels < 100 ng/mL. However, exceptions to these rules are not rare. On the other hand, among patients with macroprolactinomas (MACs), artificially low PRL levels may result from the so-called “hook effect”. Patients harboring cystic MACs may also present with a mild PRL elevation. The screening for macroprolactin is mostly indicated for asymptomatic patients and those with apparent idiopathic hyperprolactinemia. Dopamine agonists (DAs) are the treatment of choice for prolactinomas, particularly cabergoline, which is more effective and better tolerated than bromocriptine. After 2 years of successful treatment, DA withdrawal should be considered in all cases of microprolactinomas and in selected cases of MACs. In this publication, the goal of the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism (SBEM) is to provide a review of the diagnosis and treatment of hyperprolactinemia and prolactinomas, emphasizing controversial issues regarding these topics. This review is based on data published in the literature and the authors' experience. |
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Controversial issues in the management of hyperprolactinemia and prolactinomas : an overview by the Neuroendocrinology Department of the Brazilian Society of Endocrinology and MetabolismHiperprolactinemiaProlactinomaPseudoprolactinomasMacroprolactinaDopaminaCirurgiaTemozolomidaProlactinomas are the most common pituitary adenomas (approximately 40% of cases), and they represent an important cause of hypogonadism and infertility in both sexes. The magnitude of prolactin (PRL) elevation can be useful in determining the etiology of hyperprolactinemia. Indeed, PRL levels > 250 ng/mL are highly suggestive of the presence of a prolactinoma. In contrast, most patients with stalk dysfunction, drug-induced hyperprolactinemia or systemic diseases present with PRL levels < 100 ng/mL. However, exceptions to these rules are not rare. On the other hand, among patients with macroprolactinomas (MACs), artificially low PRL levels may result from the so-called “hook effect”. Patients harboring cystic MACs may also present with a mild PRL elevation. The screening for macroprolactin is mostly indicated for asymptomatic patients and those with apparent idiopathic hyperprolactinemia. Dopamine agonists (DAs) are the treatment of choice for prolactinomas, particularly cabergoline, which is more effective and better tolerated than bromocriptine. After 2 years of successful treatment, DA withdrawal should be considered in all cases of microprolactinomas and in selected cases of MACs. In this publication, the goal of the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism (SBEM) is to provide a review of the diagnosis and treatment of hyperprolactinemia and prolactinomas, emphasizing controversial issues regarding these topics. This review is based on data published in the literature and the authors' experience.Faculdade de Medicina (FMD)Sociedade Brasileira de Endocrinologia e Metabologia2019-01-02T13:57:53Z2019-01-02T13:57:53Z2018info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfVILAR, Lucio et al. 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, São Paulo, v. 62, n. 2, p. 236-263, mar. 2018. DOI: http://dx.doi.org/10.20945/2359-3997000000032. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S2359-39972018000200236&lng=en&nrm=iso. Acesso em: 29 jan. 2019.http://repositorio.unb.br/handle/10482/33729http://dx.doi.org/10.20945/2359-3997000000032Archives of Endocrinology and Metabolism - (CC BY) This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Fonte: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S2359-39972018000200236&lng=en&nrm=iso. Acesso em: 29 jan. 2019.info:eu-repo/semantics/openAccessVilar, LucioAbucham, JulioAlbuquerque, José LucianoAraujo, Luiz AntônioAzevedo, Monalisa F.Boguszewski, Cesar LuizCasulari, Luiz AugustoCunha Neto, Malebranche B. C.Czepielewski, Mauro AntonioDuarte, Felipe H. G.Faria, Manuel dos S.Gadelha, Monica R.Garmes, Heraldo M.Glezer, AndreaGurgel, Maria HelaneJallad, Raquel S.Martins, ManoelMiranda, Paulo A. C.Montenegro, Renan M.Musolino, Nina R. C.Naves, Luciana AnsaneliRibeiro-Oliveira Júnior, AntônioSilva, Cíntia M. S.Viecceli, CamilaBronstein, Marcello D.engreponame:Repositório Institucional da UnBinstname:Universidade de Brasília (UnB)instacron:UNB2023-08-22T19:51:29Zoai:repositorio.unb.br:10482/33729Repositório InstitucionalPUBhttps://repositorio.unb.br/oai/requestrepositorio@unb.bropendoar:2023-08-22T19:51:29Repositório Institucional da UnB - Universidade de Brasília (UnB)false |
dc.title.none.fl_str_mv |
Controversial issues in the management of hyperprolactinemia and prolactinomas : an overview by the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism |
title |
Controversial issues in the management of hyperprolactinemia and prolactinomas : an overview by the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism |
spellingShingle |
Controversial issues in the management of hyperprolactinemia and prolactinomas : an overview by the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism Vilar, Lucio Hiperprolactinemia Prolactinoma Pseudoprolactinomas Macroprolactina Dopamina Cirurgia Temozolomida |
title_short |
Controversial issues in the management of hyperprolactinemia and prolactinomas : an overview by the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism |
title_full |
Controversial issues in the management of hyperprolactinemia and prolactinomas : an overview by the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism |
title_fullStr |
Controversial issues in the management of hyperprolactinemia and prolactinomas : an overview by the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism |
title_full_unstemmed |
Controversial issues in the management of hyperprolactinemia and prolactinomas : an overview by the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism |
title_sort |
Controversial issues in the management of hyperprolactinemia and prolactinomas : an overview by the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism |
author |
Vilar, Lucio |
author_facet |
Vilar, Lucio Abucham, Julio Albuquerque, José Luciano Araujo, Luiz Antônio Azevedo, Monalisa F. Boguszewski, Cesar Luiz Casulari, Luiz Augusto Cunha Neto, Malebranche B. C. Czepielewski, Mauro Antonio Duarte, Felipe H. G. Faria, Manuel dos S. Gadelha, Monica R. Garmes, Heraldo M. Glezer, Andrea Gurgel, Maria Helane Jallad, Raquel S. Martins, Manoel Miranda, Paulo A. C. Montenegro, Renan M. Musolino, Nina R. C. Naves, Luciana Ansaneli Ribeiro-Oliveira Júnior, Antônio Silva, Cíntia M. S. Viecceli, Camila Bronstein, Marcello D. |
author_role |
author |
author2 |
Abucham, Julio Albuquerque, José Luciano Araujo, Luiz Antônio Azevedo, Monalisa F. Boguszewski, Cesar Luiz Casulari, Luiz Augusto Cunha Neto, Malebranche B. C. Czepielewski, Mauro Antonio Duarte, Felipe H. G. Faria, Manuel dos S. Gadelha, Monica R. Garmes, Heraldo M. Glezer, Andrea Gurgel, Maria Helane Jallad, Raquel S. Martins, Manoel Miranda, Paulo A. C. Montenegro, Renan M. Musolino, Nina R. C. Naves, Luciana Ansaneli Ribeiro-Oliveira Júnior, Antônio Silva, Cíntia M. S. Viecceli, Camila Bronstein, Marcello D. |
author2_role |
author author author author author author author author author author author author author author author author author author author author author author author author |
dc.contributor.author.fl_str_mv |
Vilar, Lucio Abucham, Julio Albuquerque, José Luciano Araujo, Luiz Antônio Azevedo, Monalisa F. Boguszewski, Cesar Luiz Casulari, Luiz Augusto Cunha Neto, Malebranche B. C. Czepielewski, Mauro Antonio Duarte, Felipe H. G. Faria, Manuel dos S. Gadelha, Monica R. Garmes, Heraldo M. Glezer, Andrea Gurgel, Maria Helane Jallad, Raquel S. Martins, Manoel Miranda, Paulo A. C. Montenegro, Renan M. Musolino, Nina R. C. Naves, Luciana Ansaneli Ribeiro-Oliveira Júnior, Antônio Silva, Cíntia M. S. Viecceli, Camila Bronstein, Marcello D. |
dc.subject.por.fl_str_mv |
Hiperprolactinemia Prolactinoma Pseudoprolactinomas Macroprolactina Dopamina Cirurgia Temozolomida |
topic |
Hiperprolactinemia Prolactinoma Pseudoprolactinomas Macroprolactina Dopamina Cirurgia Temozolomida |
description |
Prolactinomas are the most common pituitary adenomas (approximately 40% of cases), and they represent an important cause of hypogonadism and infertility in both sexes. The magnitude of prolactin (PRL) elevation can be useful in determining the etiology of hyperprolactinemia. Indeed, PRL levels > 250 ng/mL are highly suggestive of the presence of a prolactinoma. In contrast, most patients with stalk dysfunction, drug-induced hyperprolactinemia or systemic diseases present with PRL levels < 100 ng/mL. However, exceptions to these rules are not rare. On the other hand, among patients with macroprolactinomas (MACs), artificially low PRL levels may result from the so-called “hook effect”. Patients harboring cystic MACs may also present with a mild PRL elevation. The screening for macroprolactin is mostly indicated for asymptomatic patients and those with apparent idiopathic hyperprolactinemia. Dopamine agonists (DAs) are the treatment of choice for prolactinomas, particularly cabergoline, which is more effective and better tolerated than bromocriptine. After 2 years of successful treatment, DA withdrawal should be considered in all cases of microprolactinomas and in selected cases of MACs. In this publication, the goal of the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism (SBEM) is to provide a review of the diagnosis and treatment of hyperprolactinemia and prolactinomas, emphasizing controversial issues regarding these topics. This review is based on data published in the literature and the authors' experience. |
publishDate |
2018 |
dc.date.none.fl_str_mv |
2018 2019-01-02T13:57:53Z 2019-01-02T13:57:53Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
VILAR, Lucio et al. 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, São Paulo, v. 62, n. 2, p. 236-263, mar. 2018. DOI: http://dx.doi.org/10.20945/2359-3997000000032. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S2359-39972018000200236&lng=en&nrm=iso. Acesso em: 29 jan. 2019. http://repositorio.unb.br/handle/10482/33729 http://dx.doi.org/10.20945/2359-3997000000032 |
identifier_str_mv |
VILAR, Lucio et al. 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, São Paulo, v. 62, n. 2, p. 236-263, mar. 2018. DOI: http://dx.doi.org/10.20945/2359-3997000000032. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S2359-39972018000200236&lng=en&nrm=iso. Acesso em: 29 jan. 2019. |
url |
http://repositorio.unb.br/handle/10482/33729 http://dx.doi.org/10.20945/2359-3997000000032 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Sociedade Brasileira de Endocrinologia e Metabologia |
publisher.none.fl_str_mv |
Sociedade Brasileira de Endocrinologia e Metabologia |
dc.source.none.fl_str_mv |
reponame:Repositório Institucional da UnB instname:Universidade de Brasília (UnB) instacron:UNB |
instname_str |
Universidade de Brasília (UnB) |
instacron_str |
UNB |
institution |
UNB |
reponame_str |
Repositório Institucional da UnB |
collection |
Repositório Institucional da UnB |
repository.name.fl_str_mv |
Repositório Institucional da UnB - Universidade de Brasília (UnB) |
repository.mail.fl_str_mv |
repositorio@unb.br |
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1814508247932993536 |