Controversial issues in the management of hyperprolactinemia and prolactinomas : an overview by the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism

Detalhes bibliográficos
Autor(a) principal: Vilar, Lucio
Data de Publicação: 2018
Outros Autores: 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.
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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spelling 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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