Department of Endocrinology, Centre Hospitalier Universitaire de Liège, Liège Université, Liège, Belgium.
Department of Endocrinology, Centre Hospitalier Universitaire de Liège, Liège Université, Liège, Belgium,
Neuroendocrinology. 2019;109(1):20-27. doi: 10.1159/000497746. Epub 2019 Feb 7.
Clinically relevant pituitary adenomas are present in about 1 per 1,000 of the general population and prolactinomas are by far the most common clinical subtype of pituitary adenomas. Usually prolactinomas affect premenopausal women and present with typical symptoms of menstrual disturbance and/or galactorrhea. They are generally managed with dopamine agonists to restore fertility and to control symptoms and tumor size. In a subset of prolactinomas, however, management remains challenging. Studies in recent years have identified the factors related to dopamine agonist resistance, such as male sex, genetic features, and aggressive tumor behavior. Certain other patient groups represent particular challenges for management, such as pediatric patients and pregnant women. Treatment with dopamine agonists is usually safe and effective, and adverse effects such as clinically relevant cardiac valvular complications and impulse control disorders may occur in isolated instances. A number of important disease characteristics of prolactinomas remain to be explained, such as the difference in sex prevalence before and after menopause, the higher prevalence of macroadenomas in older males, and the biochemical mechanisms of resistance to dopaminergic agonists.
临床上相关的垂体腺瘤在普通人群中约占 1/1000，而泌乳素瘤是迄今为止最常见的垂体腺瘤临床亚型。通常，泌乳素瘤影响绝经前妇女，并表现出典型的月经紊乱和/或溢乳症状。它们通常通过多巴胺激动剂治疗来恢复生育能力并控制症状和肿瘤大小。然而，在一部分泌乳素瘤中，管理仍然具有挑战性。近年来的研究已经确定了与多巴胺激动剂耐药相关的因素，例如男性、遗传特征和侵袭性肿瘤行为。某些其他患者群体，如儿科患者和孕妇，代表着管理上的特殊挑战。多巴胺激动剂治疗通常是安全有效的，并且在个别情况下可能会出现临床相关的心脏瓣膜并发症和冲动控制障碍等不良反应。泌乳素瘤的许多重要疾病特征仍有待解释，例如绝经前后性别患病率的差异、老年男性大腺瘤患病率较高，以及对多巴胺能激动剂耐药的生化机制。
