Standardized diagnosis and treatment of pituitary prolactin-secreting adenoma: interpretation of 2023 Pituitary Society international consensus statement_West China Medical Journal

Authors：

LIU Yuke ^1,2 ,  TAN Huiwen ^1,2 , Cholekho Sumita ^1,2

1. Department of Endocrinology & Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Center of Pituitary Adenoma and Related Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

TAN Huiwen, Email: tanhuiwen2016@scu.edu.cn

Keywords：

Pituitary tumor; hyperprolactinemia; prolactin-secreting adenoma; diagnosis; treatment; guideline interpretation

DOI：

10.7507/1002-0179.202309194

Video：

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Pituitary Society released an international consensus statement on the diagnosis and management of prolactin-secreting adenoma (PRLoma) on September 5, 2023, providing recommendations based on the latest evidence-based approach for the screening, diagnosis, treatment and management of PRLoma. This consensus statement not only updated the clinical epidemiology, pathogenesis, clinical symptoms, complications, diagnostic criteria, and treatment progress of pituitary PRLoma, but also focused on special populations such as pregnant women, postmenopausal women, children/adolescents, transgender patients, as well as the treatment of special types such as cystic and invasive pituitary PRLoma. This article aims to help neurosurgeons, endocrinologists, and related healthcare professionals standardize the diagnosis and treatment of PRLoma by interpreting the updated section of the consensus.

Citation： LIU Yuke, TAN Huiwen, Cholekho Sumita. Standardized diagnosis and treatment of pituitary prolactin-secreting adenoma: interpretation of 2023 Pituitary Society international consensus statement. West China Medical Journal, 2023, 38(12): 1801-1806. doi: 10.7507/1002-0179.202309194 Copy

1.	Petersenn S, Fleseriu M, Casanueva FF, et al. Diagnosis and management of prolactin-secreting pituitary adenomas: a Pituitary Society international consensus statement. Nat Rev Endocrinol, 2023, 19(12): 722-740.
2.	Melmed S, Casanueva FF, Hoffman AR, et al. Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab, 2011, 96(2): 273-288.
3.	Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ, 2008, 336(7650): 924-926.
4.	Swiglo BA, Murad MH, Schünemann HJ, et al. A case for clarity, consistency, and helpfulness: state-of-the-art clinical practice guidelines in endocrinology using the grading of recommendations, assessment, development, and evaluation system. J Clin Endocrinol Metab, 2008, 93(3): 666-673.
5.	Chanson P, Maiter D. The epidemiology, diagnosis and treatment of prolactinomas: the old and the new. Best Pract Res Clin Endocrinol Metab, 2019, 33(2): 101290.
6.	Vroonen L, Daly AF, Beckers A. Epidemiology and management challenges in prolactinomas. Neuroendocrinology, 2019, 109(1): 20-27.
7.	Cozzi R, Ambrosio MR, Attanasio R, et al. Italian Association of Clinical Endocrinologists (AME) and International Chapter of Clinical Endocrinology (ICCE). Position statement for clinical practice: prolactin-secreting tumors. Eur J Endocrinol, 2022, 186(3): 1-33.
8.	中国垂体腺瘤协作组. 中国垂体催乳素腺瘤诊治共识(2014 版). 中华医学杂志, 2014(31): 2406-2411.
9.	Barber TM, Kyrou I, Kaltsas G, et al. Mechanisms of central hypogonadism. Int J Mol Sci, 2021, 22(15): 8217.
10.	Molitch ME. Diagnosis and treatment of pituitary adenomas: a review. JAMA, 2017, 317(5): 516-524.
11.	Vilar L, Vilar CF, Lyra R, et al. Pitfalls in the diagnostic evaluation of hyperprolactinemia. Neuroendocrinology, 2019, 109(1): 7-19.
12.	Kronenberg HM, Melmed S, Polonsky KS. Williams textbook of endocrinology. 11th ed. Philadelphia: Saunders Elsevier, 2011: 185-261.
13.	Kaiser U, Ho K. Pituitary physiology and diagnostic evaluation. Philadelphia: Elsevier, 2019: 184-235.
14.	Melmed S. Pituitary-tumor endocrinopathies. N Engl J Med, 2020, 382(10): 937-950.
15.	Schernthaner-Reiter MH, Trivellin G, Stratakis CA. MEN1, MEN4, and carney complex: pathology and molecular genetics. Neuroendocrinology, 2016, 103(1): 18-31.
16.	Gorvin CM, Newey PJ, Rogers A, et al. Association of prolactin receptor (PRLR) variants with prolactinomas. Hum Mol Genet, 2019, 28(6): 1023-1037.
17.	Cote DJ, Kilgallon JL, Nawabi NLA, et al. Oral contraceptive and menopausal hormone therapy use and risk of pituitary adenoma: cohort and case-control analyses. J Clin Endocrinol Metab, 2022, 107(4): e1402-e1412.
18.	Fukuhara N, Nishiyama M, Iwasaki Y. Update in pathogenesis, diagnosis, and therapy of prolactinoma. Cancers (Basel), 2022, 14(15): 3604.
19.	Bjune JI, Strømland PP, Jersin RÅ, et al. Metabolic and epigenetic regulation by estrogen in adipocytes. Front Endocrinol (Lausanne), 2022, 13: 828780.
20.	Li C, Xie W, Rosenblum JS, et al. Somatic SF3B1 hotspot mutation in prolactinomas. Nat Commun, 2020, 11(1): 2506.
21.	Petersenn S. Biochemical diagnosis in prolactinomas: some caveats. Pituitary, 2020, 23(1): 9-15.
22.	Raverot V, Perrin P, Chanson P, et al. Prolactin immunoassay: does the high-dose hook effect still exist?. Pituitary, 2022, 25(4): 653-657.
23.	Nachtigall LB, Karavitaki N, Kiseljak-Vassiliades K, et al. Physicians’ awareness of gadolinium retention and MRI timing practices in the longitudinal management of pituitary tumors: a “Pituitary Society” survey. Pituitary, 2019, 22(1): 37-45.
24.	Fleseriu M, Hashim IA, Karavitaki N, et al. Hormonal replacement in hypopituitarism in adults: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab, 2016, 101(11): 3888-3921.
25.	Mancini T, Casanueva FF, Giustina A. Hyperprolactinemia and prolactinomas. Endocrinol Metab Clin North Am, 2008, 37(1): 67-99.
26.	Verhelst J, Abs R, Maiter D, et al. Cabergoline in the treatment of hyperprolactinemia: a study in 455 patients. J Clin Endocrinol Metab, 1999, 84(7): 2518-2522.
27.	Gillam MP, Molitch ME, Lombardi G, et al. Advances in the treatment of prolactinomas. Endocr Rev, 2006, 27(5): 485-534.
28.	Steeds R, Stiles C, Sharma V, et al. Echocardiography and monitoring patients receiving dopamine agonist therapy for hyperprolactinaemia: a joint position statement of the British Society of Echocardiography, the British Heart Valve Society and the Society for Endocrinology. Clin Endocrinol (Oxf), 2019, 90(5): 662-669.
29.	Ioachimescu AG, Fleseriu M, Hoffman AR, et al. Psychological effects of dopamine agonist treatment in patients with hyperprolactinemia and prolactin-secreting adenomas. Eur J Endocrinol, 2019, 180(1): 31-40.
30.	De Sousa SMC, Baranoff J, Rushworth RL, et al. Impulse control disorders in dopamine agonist-treated hyperprolactinemia: prevalence and risk factors. J Clin Endocrinol Metab, 2020, 105(3): dgz076.
31.	Andereggen L, Frey J, Andres RH, et al. First-line surgery in prolactinomas: lessons from a long-term follow-up study in a tertiary referral center. J Endocrinol Invest, 2021, 44(12): 2621-2633.
32.	Lam G, Mehta V, Zada G. Spontaneous and medically induced cerebrospinal fluid leakage in the setting of pituitary adenomas: review of the literature. Neurosurg Focus, 2012, 32(6): E2.
33.	Buchfelder M, Zhao Y, Schlaffer SM. Surgery for prolactinomas to date. Neuroendocrinology, 2019, 109(1): 77-81.
34.	Wright K, Chaker L, Pacione D, et al. Determinants of surgical remission in prolactinomas: a systematic review and meta-analysis. World Neurosurg, 2021, 154: e349-e369.
35.	Sant’ Anna BG, Musolino NRC, Gadelha MR, et al. A Brazilian multicentre study evaluating pregnancies induced by cabergoline in patients harboring prolactinomas. Pituitary, 2020, 23(2): 120-128.
36.	Fainstein Day P, Glerean M, Lovazzano S, et al. Gender differences in macroprolactinomas: study of clinical features, outcome of patients and ki-67 expression in tumor tissue. Front Horm Res, 2010, 38: 50-58.
37.	Colao A, Vitale G, Cappabianca P, et al. Outcome of cabergoline treatment in men with prolactinoma: effects of a 24-month treatment on prolactin levels, tumor mass, recovery of pituitary function, and semen analysis. J Clin Endocrinol Metab, 2004, 89(4): 1704-1711.
38.	Nota NM, Dekker MJHJ, Klaver M, et al. Prolactin levels during short- and long-term cross-sex hormone treatment: an observational study in transgender persons. Andrologia, 2017, 49(6): 12666.
39.	Hembree WC, Cohen-Kettenis PT, Gooren L, et al. Endocrine treatment of gender-dysphoric/gender-incongruent persons: an endocrine society clinical practice guideline. J Clin Endocrinol Metab, 2017, 102(11): 3869-3903.
40.	Donoho DA, Laws ER Jr. The role of surgery in the management of prolactinomas. Neurosurg Clin N Am, 2019, 30(4): 509-514.
41.	Fleseriu M, Langlois F, Lim DST, et al. Acromegaly: pathogenesis, diagnosis, and management. Lancet Diabetes Endocrinol, 2022, 10(11): 804-826.
42.	Raverot G, Burman P, McCormack A, et al. European Society of endocrinology clinical practice guidelines for the management of aggressive pituitary tumours and carcinomas. Eur J Endocrinol, 2018, 178(1): G1-G24.
43.	Melmed S. Mechanisms for pituitary tumorigenesis: the plastic pituitary. J Clin Invest, 2003, 112(11): 1603-1618.
44.	Raverot G, Ilie MD, Lasolle H, et al. Aggressive pituitary tumours and pituitary carcinomas. Nat Rev Endocrinol, 2021, 17(11): 671-684.

1. Petersenn S, Fleseriu M, Casanueva FF, et al. Diagnosis and management of prolactin-secreting pituitary adenomas: a Pituitary Society international consensus statement. Nat Rev Endocrinol, 2023, 19(12): 722-740.
2. Melmed S, Casanueva FF, Hoffman AR, et al. Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab, 2011, 96(2): 273-288.
3. Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ, 2008, 336(7650): 924-926.
4. Swiglo BA, Murad MH, Schünemann HJ, et al. A case for clarity, consistency, and helpfulness: state-of-the-art clinical practice guidelines in endocrinology using the grading of recommendations, assessment, development, and evaluation system. J Clin Endocrinol Metab, 2008, 93(3): 666-673.
5. Chanson P, Maiter D. The epidemiology, diagnosis and treatment of prolactinomas: the old and the new. Best Pract Res Clin Endocrinol Metab, 2019, 33(2): 101290.
6. Vroonen L, Daly AF, Beckers A. Epidemiology and management challenges in prolactinomas. Neuroendocrinology, 2019, 109(1): 20-27.
7. Cozzi R, Ambrosio MR, Attanasio R, et al. Italian Association of Clinical Endocrinologists (AME) and International Chapter of Clinical Endocrinology (ICCE). Position statement for clinical practice: prolactin-secreting tumors. Eur J Endocrinol, 2022, 186(3): 1-33.
8. 中国垂体腺瘤协作组. 中国垂体催乳素腺瘤诊治共识(2014 版). 中华医学杂志, 2014(31): 2406-2411.
9. Barber TM, Kyrou I, Kaltsas G, et al. Mechanisms of central hypogonadism. Int J Mol Sci, 2021, 22(15): 8217.
10. Molitch ME. Diagnosis and treatment of pituitary adenomas: a review. JAMA, 2017, 317(5): 516-524.
11. Vilar L, Vilar CF, Lyra R, et al. Pitfalls in the diagnostic evaluation of hyperprolactinemia. Neuroendocrinology, 2019, 109(1): 7-19.
12. Kronenberg HM, Melmed S, Polonsky KS. Williams textbook of endocrinology. 11th ed. Philadelphia: Saunders Elsevier, 2011: 185-261.
13. Kaiser U, Ho K. Pituitary physiology and diagnostic evaluation. Philadelphia: Elsevier, 2019: 184-235.
14. Melmed S. Pituitary-tumor endocrinopathies. N Engl J Med, 2020, 382(10): 937-950.
15. Schernthaner-Reiter MH, Trivellin G, Stratakis CA. MEN1, MEN4, and carney complex: pathology and molecular genetics. Neuroendocrinology, 2016, 103(1): 18-31.
16. Gorvin CM, Newey PJ, Rogers A, et al. Association of prolactin receptor (PRLR) variants with prolactinomas. Hum Mol Genet, 2019, 28(6): 1023-1037.
17. Cote DJ, Kilgallon JL, Nawabi NLA, et al. Oral contraceptive and menopausal hormone therapy use and risk of pituitary adenoma: cohort and case-control analyses. J Clin Endocrinol Metab, 2022, 107(4): e1402-e1412.
18. Fukuhara N, Nishiyama M, Iwasaki Y. Update in pathogenesis, diagnosis, and therapy of prolactinoma. Cancers (Basel), 2022, 14(15): 3604.
19. Bjune JI, Strømland PP, Jersin RÅ, et al. Metabolic and epigenetic regulation by estrogen in adipocytes. Front Endocrinol (Lausanne), 2022, 13: 828780.
20. Li C, Xie W, Rosenblum JS, et al. Somatic SF3B1 hotspot mutation in prolactinomas. Nat Commun, 2020, 11(1): 2506.
21. Petersenn S. Biochemical diagnosis in prolactinomas: some caveats. Pituitary, 2020, 23(1): 9-15.
22. Raverot V, Perrin P, Chanson P, et al. Prolactin immunoassay: does the high-dose hook effect still exist?. Pituitary, 2022, 25(4): 653-657.
23. Nachtigall LB, Karavitaki N, Kiseljak-Vassiliades K, et al. Physicians’ awareness of gadolinium retention and MRI timing practices in the longitudinal management of pituitary tumors: a “Pituitary Society” survey. Pituitary, 2019, 22(1): 37-45.
24. Fleseriu M, Hashim IA, Karavitaki N, et al. Hormonal replacement in hypopituitarism in adults: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab, 2016, 101(11): 3888-3921.
25. Mancini T, Casanueva FF, Giustina A. Hyperprolactinemia and prolactinomas. Endocrinol Metab Clin North Am, 2008, 37(1): 67-99.
26. Verhelst J, Abs R, Maiter D, et al. Cabergoline in the treatment of hyperprolactinemia: a study in 455 patients. J Clin Endocrinol Metab, 1999, 84(7): 2518-2522.
27. Gillam MP, Molitch ME, Lombardi G, et al. Advances in the treatment of prolactinomas. Endocr Rev, 2006, 27(5): 485-534.
28. Steeds R, Stiles C, Sharma V, et al. Echocardiography and monitoring patients receiving dopamine agonist therapy for hyperprolactinaemia: a joint position statement of the British Society of Echocardiography, the British Heart Valve Society and the Society for Endocrinology. Clin Endocrinol (Oxf), 2019, 90(5): 662-669.
29. Ioachimescu AG, Fleseriu M, Hoffman AR, et al. Psychological effects of dopamine agonist treatment in patients with hyperprolactinemia and prolactin-secreting adenomas. Eur J Endocrinol, 2019, 180(1): 31-40.
30. De Sousa SMC, Baranoff J, Rushworth RL, et al. Impulse control disorders in dopamine agonist-treated hyperprolactinemia: prevalence and risk factors. J Clin Endocrinol Metab, 2020, 105(3): dgz076.
31. Andereggen L, Frey J, Andres RH, et al. First-line surgery in prolactinomas: lessons from a long-term follow-up study in a tertiary referral center. J Endocrinol Invest, 2021, 44(12): 2621-2633.
32. Lam G, Mehta V, Zada G. Spontaneous and medically induced cerebrospinal fluid leakage in the setting of pituitary adenomas: review of the literature. Neurosurg Focus, 2012, 32(6): E2.
33. Buchfelder M, Zhao Y, Schlaffer SM. Surgery for prolactinomas to date. Neuroendocrinology, 2019, 109(1): 77-81.
34. Wright K, Chaker L, Pacione D, et al. Determinants of surgical remission in prolactinomas: a systematic review and meta-analysis. World Neurosurg, 2021, 154: e349-e369.
35. Sant’ Anna BG, Musolino NRC, Gadelha MR, et al. A Brazilian multicentre study evaluating pregnancies induced by cabergoline in patients harboring prolactinomas. Pituitary, 2020, 23(2): 120-128.
36. Fainstein Day P, Glerean M, Lovazzano S, et al. Gender differences in macroprolactinomas: study of clinical features, outcome of patients and ki-67 expression in tumor tissue. Front Horm Res, 2010, 38: 50-58.
37. Colao A, Vitale G, Cappabianca P, et al. Outcome of cabergoline treatment in men with prolactinoma: effects of a 24-month treatment on prolactin levels, tumor mass, recovery of pituitary function, and semen analysis. J Clin Endocrinol Metab, 2004, 89(4): 1704-1711.
38. Nota NM, Dekker MJHJ, Klaver M, et al. Prolactin levels during short- and long-term cross-sex hormone treatment: an observational study in transgender persons. Andrologia, 2017, 49(6): 12666.
39. Hembree WC, Cohen-Kettenis PT, Gooren L, et al. Endocrine treatment of gender-dysphoric/gender-incongruent persons: an endocrine society clinical practice guideline. J Clin Endocrinol Metab, 2017, 102(11): 3869-3903.
40. Donoho DA, Laws ER Jr. The role of surgery in the management of prolactinomas. Neurosurg Clin N Am, 2019, 30(4): 509-514.
41. Fleseriu M, Langlois F, Lim DST, et al. Acromegaly: pathogenesis, diagnosis, and management. Lancet Diabetes Endocrinol, 2022, 10(11): 804-826.
42. Raverot G, Burman P, McCormack A, et al. European Society of endocrinology clinical practice guidelines for the management of aggressive pituitary tumours and carcinomas. Eur J Endocrinol, 2018, 178(1): G1-G24.
43. Melmed S. Mechanisms for pituitary tumorigenesis: the plastic pituitary. J Clin Invest, 2003, 112(11): 1603-1618.
44. Raverot G, Ilie MD, Lasolle H, et al. Aggressive pituitary tumours and pituitary carcinomas. Nat Rev Endocrinol, 2021, 17(11): 671-684.

West China Medical Journal

Standardized diagnosis and treatment of pituitary prolactin-secreting adenoma: interpretation of 2023 Pituitary Society international consensus statement

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