ENDOC Center for Endocrine Tumors, Hamburg, Germany.
University of Duisburg-Essen, Essen, Germany.
Nat Rev Endocrinol. 2023 Dec;19(12):722-740. doi: 10.1038/s41574-023-00886-5. Epub 2023 Sep 5.
This Consensus Statement from an international, multidisciplinary workshop sponsored by the Pituitary Society offers evidence-based graded consensus recommendations and key summary points for clinical practice on the diagnosis and management of prolactinomas. Epidemiology and pathogenesis, clinical presentation of disordered pituitary hormone secretion, assessment of hyperprolactinaemia and biochemical evaluation, optimal use of imaging strategies and disease-related complications are addressed. In-depth discussions present the latest evidence on treatment of prolactinoma, including efficacy, adverse effects and options for withdrawal of dopamine agonist therapy, as well as indications for surgery, preoperative medical therapy and radiation therapy. Management of prolactinoma in special situations is discussed, including cystic lesions, mixed growth hormone-secreting and prolactin-secreting adenomas and giant and aggressive prolactinomas. Furthermore, considerations for pregnancy and fertility are outlined, as well as management of prolactinomas in children and adolescents, patients with an underlying psychiatric disorder, postmenopausal women, transgender individuals and patients with chronic kidney disease. The workshop concluded that, although treatment resistance is rare, there is a need for additional therapeutic options to address clinical challenges in treating these patients and a need to facilitate international registries to enable risk stratification and optimization of therapeutic strategies.
这份由垂体学会赞助的国际多学科研讨会的共识声明，就催乳素瘤的诊断和管理提供了基于证据的分级共识推荐和临床实践要点。涵盖了流行病学和发病机制、垂体激素分泌紊乱的临床表现、高催乳素血症的评估和生化评估、影像学策略的最佳应用以及与疾病相关的并发症。深入的讨论介绍了催乳素瘤治疗的最新证据，包括疗效、不良反应以及停止多巴胺激动剂治疗的选择，以及手术、术前药物治疗和放射治疗的适应证。还讨论了特殊情况下催乳素瘤的管理，包括囊性病变、混合生长激素分泌和催乳素分泌腺瘤以及巨大和侵袭性催乳素瘤。此外，还概述了妊娠和生育能力的注意事项，以及儿童和青少年患者、有潜在精神疾病的患者、绝经后妇女、跨性别者和慢性肾脏病患者的催乳素瘤的管理。研讨会得出结论，尽管治疗抵抗很少见，但需要额外的治疗选择来应对治疗这些患者的临床挑战，需要促进国际登记处的建立，以实现风险分层和治疗策略的优化。
