Title:Italian Guidelines for the Management of Prolactinomas
Volume: 23
Issue: 12
Author(s): Renato Cozzi, Renata Simona Auriemma, Ernesto De Menis, Felice Esposito, Emanuele Ferrante, Giuseppe Iatì, Diego Mazzatenta, Maurizio Poggi, Roberta Rudà, Fabio Tortora, Fabio Cruciani, Zuzana Mitrova, Rosella Saulle, Simona Vecchi, Michele Basile, Paolo Cappabianca, Agostino Paoletta, Enrico Papini, Agnese Persichetti, Irene Samperi, Alessandro Scoppola, Alessandro Bozzao, Marco Caputo, Francesco Doglietto, Francesco Ferraù, Andrea Gerardo Lania, Stefano Laureti, Stefano Lello, Davide Locatelli, Pietro Maffei, Giuseppe Minniti, Alessandro Peri, Chiara Ruini, Fabio Settanni, Antonio Silvani, Nadia Veronese, Franco Grimaldi and Roberto Attanasio*
Affiliation:
- AME Scientific Committee, Milan, Italy
Keywords:
Prolactinoma, prolactin-secreting tumor, microprolactinoma, macroprolactinoma, cost-efficacy analysis, cabergoline, bromocriptine, neurosurgery, radiotherapy, temozolomide.
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.