Italian Guidelines for the Management of Prolactinomas.

Pietro Maffei, Alessandro Scoppola, Alessandro Bozzao, Marco Caputo, Francesco Doglietto, Francesco Ferraù, Andrea Gerardo Lania, Stefano Laureti, Stefano Lello, Davide Locatelli, Irene Samperi, Giuseppe Minniti, Alessandro Peri, Chiara Ruini, Fabio Settanni, Antonio Silvani, Nadia Veronese, Franco Grimaldi, Roberto Attanasio, Fabio Cruciani, Renato Cozzi, Renata Simona Auriemma, Ernesto De Menis, Felice Esposito, Giuseppe Iatì, Diego Mazzatenta, Maurizio Poggi, Roberta Rudà, Fabio Tortora, Emanuele Ferrante, Zuzana Mitrova, Rosella Saulle, Simona Vecchi, Michele Basile, Paolo Cappabianca, Agostino Paoletta, Enrico Papini, Agnese Persichetti

Journal: Endocrine, metabolic & immune disorders drug targets 2023;23(12):1459-1479

PMID: 37171003

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Abstract

INTRODUCTION

This guideline (GL) is aimed at providing a reference for the management of prolactin (PRL)-secreting pituitary adenoma in adults. However, pregnancy is not considered.

METHODS

This GL has been developed following the methods described in the Manual of the Italian National Guideline System. For each question, the panel appointed by Associazione Medici Endocrinologi (AME) has identified potentially relevant outcomes, which have then been rated for their impact on therapeutic choices. Only outcomes classified as "critical" and "important" have been considered in the systematic review of evidence and only those classified as "critical" have been considered in the formulation of recommendations.

RESULTS

The present GL provides recommendations regarding the role of pharmacological and neurosurgical treatment in the management of prolactinomas. We recommend cabergoline (Cab) vs. bromocriptine (Br) as the firstchoice pharmacological treatment to be employed at the minimal effective dose capable of achieving the regression of the clinical picture. We suggest that medication and surgery are offered as suitable alternative first-line treatments to patients with non-invasive PRL-secreting adenoma, regardless of size. We suggest Br as an alternative drug in patients who are intolerant to Cab and are not candidates for surgery. We recommend pituitary tumor resection in patients 1) without any significant neuro-ophthalmologic improvement within two weeks from the start of Cab, 2) who are resistant or do not tolerate Cab or other dopamine-agonist drugs (DA), 3) who escape from previous efficacy of DA, and 4) who are unwilling to undergo a chronic DA treatment. We recommend that patients with progressive disease notwithstanding previous tumor resection and ongoing DA should be managed by a multidisciplinary team with specific expertise in pituitary diseases using a multimodal approach that includes repeated surgery, radiotherapy, DA, and possibly, the use of temozolomide.

CONCLUSION

The present GL is directed to endocrinologists, neurosurgeons, and gynecologists working in hospitals, in territorial services or private practice, and to general practitioners and patients.

Address: Department of Endocrinology ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.; Department of Molecular and Clinical Endocrinology and Oncology, Federico II University of Naples, Italy.; Internal Medicine 2, Treviso Hospital, Treviso; Functional Department of Endocrinology and Metabolism, AULSS 2 Veneto, Italy.; Neurosurgical Clinic, Department of Neurosciences and Reproductive and Odontostomatological Sciences, "Federico II" University of Naples, Italy.; Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.; Department of Radiation Oncology, University of Messina, Italy.; Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neurochirurgia Ipofisi - Pituitary Unit, Bologna, Italy.; Endocrinology, Department of Clinical and Molecular Medicine, S. Andrea Hospital, Sapienza University of Rome, Italy.; Division of Neurology, Castelfranco Veneto and Treviso Hospital, Treviso; Division of Neuro-Oncology, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Italy.; Radiology Unit, Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy.; Department of Epidemiology, Lazio Region Health Service, Rome, Italy.; High School of Economy and Management of Health Systems, Catholic University of Sacred Heart, Rome, Italy.; Endocrinology, ULSS6 Euganea, Padova, Italy.; Endocrinology, Ospedale Regina Apostolorum, Albano Laziale.; Ministry of Interior - Department of Firefighters, Public Rescue and Civil Defense, Rome, Italy.; Endocrinology, ASL Novara, Italy.; Endocrinology, Ospedale Santo Spirito, Rome, Italy.; Neuroradiology, S. Andrea Hospital, NESMOS Department (Neuroscience, Mental Health, Sensorial Organs), Sapienza University of Rome, Italy.; Laboratorio Analisi Cliniche e Microbiologia, Synlab SRL, Calenzano (FI), Italy.; Institute of Neurosurgery, Catholic University School of Medicine, Rome, Italy.; Department of Human Pathology of Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy.; Department of Biomedical Sciences, Endocrinology Unit, Humanitas Clinical and Research Center IRCCS, Humanitas University, Rozzano (MI), Italy.; General Practitioner, USL Umbria 1, Perugia, Italy.; Department of Woman and Child Health and Public Health, Institute of Obstetrics and Gynecology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.; Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi, Varese, Italy.; Department of Medicine (DIMED), 3rd Medical Clinic, Padua University, Italy.; Radiation Oncology Unit, Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy.; Pituitary Diseases and Sodium Alterations Unit, Endocrinology, AOU Careggi, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Italy.; Department of Psychology, University of Bologna, Italy.; Clinical Biochemistry Laboratory, City of Health and Science University Hospital, Turin, Italy.; Department of Neuro-Oncology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy.; AME past President, Udine, Italy.; AME Scientific Committee, Milan, Italy.

DOI: 10.2174/1871530323666230511104045

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MeSH Terms: Adult, Humans, Bromocriptine, Cabergoline, Dopamine Agonists, Ergolines, Pituitary Neoplasms, Prolactin, Prolactinoma