PMID- 34934445
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20211223
IS  - 1792-1015 (Electronic)
IS  - 1792-0981 (Print)
IS  - 1792-0981 (Linking)
VI  - 23
IP  - 1
DP  - 2022 Jan
TI  - Aggressive prolactinoma (Review).
PG  - 74
LID - 10.3892/etm.2021.10997 [doi]
LID - 74
AB  - Aggressive prolactinoma (APRL) is a subgroup of aggressive pituitary tumors 
      (accounting for 10% of all hypophyseal neoplasia) which are defined by: invasion 
      based on radiological and/or histological features, a higher proliferation 
      profile when compared to typical adenomas and rapidly developing resistance to 
      standard medication/protocols in addition to an increased risk of early 
      recurrence. This is a narrative review focusing on APRL in terms of both 
      presentation and management. Upon admission, the suggestive features may include 
      increased serum prolactin with a large tumor diameter (mainly >4 cm), male sex, 
      early age at diagnosis (<20 years), and genetic predisposition [multiple 
      endocrine neoplasia type 1 (MEN1), aryl hydrocarbon receptor interacting protein 
      (AIP), succinate dehydrogenase (SDHx) gene mutations]. Potential prognostic 
      factors are indicated by assessment of E-cadherin, matrix metalloproteinase 
      (MMP)-9, and vascular endothelial growth factor (VEGF) status. Furthermore, 
      during management, APRL may be associated with dopamine agonist (DA) resistance 
      (described in 10-20% of all prolactinomas), post-hypophysectomy relapse, mitotic 
      count >2, Ki-67 proliferation index >/=3%, the need for radiotherapy, lack of 
      response in terms of controlling prolactin levels and tumor growth despite 
      multimodal therapy. However, none of these as an isolated element serves as a 
      surrogate of APRL diagnosis. A fourth-line therapy is necessary with 
      temozolomide, an oral alkylating chemotherapeutic agent, that may induce tumor 
      reduction and serum prolactin reduction in 75% of cases but only 8% have a 
      normalization of prolactin levels. Controversies surrounding the duration of 
      therapy still exist; also regarding the fifth-line therapy, post-temozolomide 
      intervention. Recent data suggest alternatives such as somatostatin analogues 
      (pasireotide), checkpoint inhibitors (ipilimumab, nivolumab), tyrosine kinase 
      inhibitors (TKIs) (lapatinib), and mTOR inhibitors (everolimus). APRL represents 
      a complex condition that is still challenging, and multimodal therapy is 
      essential.
CI  - Copyright (c) 2020, Spandidos Publications.
FAU - Valea, Ana
AU  - Valea A
AD  - Department of Endocrinology, 'I. Hatieganu' University of Medicine and Pharmacy, 
      400012 Cluj-Napoca, Romania.
AD  - Department of Endocrinology, Clinical County Hospital, 400000 Cluj-Napoca, 
      Romania.
FAU - Sandru, Florica
AU  - Sandru F
AD  - Department of Dermatology, 'Carol Davila' University of Medicine and Pharmacy, 
      050474 Bucharest, Romania.
AD  - Department of Dermatology, 'Elias' University Emergency Hospital, 011461 
      Bucharest, Romania.
FAU - Petca, Aida
AU  - Petca A
AD  - Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine 
      and Pharmacy, 020021 Bucharest, Romania.
AD  - Department of Obstetrics and Gynecology, 'Elias' University Emergency Hospital, 
      011461 Bucharest, Romania.
FAU - Dumitrascu, Mihai Cristian
AU  - Dumitrascu MC
AD  - Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine 
      and Pharmacy, 020021 Bucharest, Romania.
AD  - Department of Obstetrics and Gynecology, University Emergency Hospital, 050098 
      Bucharest, Romania.
FAU - Carsote, Mara
AU  - Carsote M
AD  - Department of Endocrinology, 'Carol Davila' University of Medicine and Pharmacy, 
      050474 Bucharest, Romania.
AD  - Department of Endocrinology, 'C. I. Parhon' National Institute of Endocrinology, 
      011863 Bucharest, Romania.
FAU - Petca, Razvan-Cosmin
AU  - Petca RC
AD  - Department of Urology, 'Carol Davila' University of Medicine and Pharmacy, 050474 
      Bucharest, Romania.
AD  - Department of Urology, 'Prof. Dr. Theodor Burgele' Clinical Hospital, 061344 
      Bucharest, Romania.
FAU - Ghemigian, Adina
AU  - Ghemigian A
AD  - Department of Endocrinology, 'Carol Davila' University of Medicine and Pharmacy, 
      050474 Bucharest, Romania.
AD  - Department of Endocrinology, 'C. I. Parhon' National Institute of Endocrinology, 
      011863 Bucharest, Romania.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20211124
PL  - Greece
TA  - Exp Ther Med
JT  - Experimental and therapeutic medicine
JID - 101531947
PMC - PMC8652381
OTO - NOTNLM
OT  - aggressive pituitary tumor
OT  - aggressive prolactinoma
OT  - cabergoline
OT  - hypophysectomy
OT  - menses
OT  - menstrual cycle
OT  - pituitary carcinoma
OT  - prolactin
OT  - prolactinoma
OT  - temozolomide
COIS- The authors declare that they have no competing interests.
EDAT- 2021/12/23 06:00
MHDA- 2021/12/23 06:01
PMCR- 2021/11/24
CRDT- 2021/12/22 06:48
PHST- 2021/07/06 00:00 [received]
PHST- 2021/08/05 00:00 [accepted]
PHST- 2021/12/22 06:48 [entrez]
PHST- 2021/12/23 06:00 [pubmed]
PHST- 2021/12/23 06:01 [medline]
PHST- 2021/11/24 00:00 [pmc-release]
AID - ETM-0-0-10997 [pii]
AID - 10.3892/etm.2021.10997 [doi]
PST - ppublish
SO  - Exp Ther Med. 2022 Jan;23(1):74. doi: 10.3892/etm.2021.10997. Epub 2021 Nov 24.