Dopamine agonist–resistant prolactinomas

A review

Michael C. Oh M.D., Ph.D. and Manish K. Aghi M.D., Ph.D.
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  • California Center for Pituitary Disorders, Department of Neurological Surgery, University of California, San Francisco, California
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The authors' object in this paper was to review the definition, epidemiology, biology, resistance mechanisms, and treatment options for dopamine agonist–resistant prolactinomas (DARPs).

Prolactinomas are relatively unique among primary brain tumors in that medical treatment alone using dopamine agonists carries a high probability of disease control or even radiographic and endocrine remission, and thus has replaced surgery as the first line of therapy. Unfortunately, slightly less than 10% of patients with prolactinomas do not experience normalization of their prolactin levels in response to dopamine agonists, and harbor tumors that are resistant to dopamine agonist therapy. A literature review underscores that in male patients these DARPs are more likely to be invasive macroadenomas than dopamine agonist–responsive prolactinomas and that they are also more angiogenic, more proliferative, and more likely to exhibit cellular atypia. Estrogen receptor antagonists and temozolomide are the most commonly applied medical therapies in cases in which resection and radiosurgery have not induced remission of the hyperprolactinemia.

Dopamine agonist–resistant prolactinomas exhibit aggressive behavior and tend to be large, invasive, hyperangiogenic tumors with high mitotic indices, which makes their management via surgery, radiosurgery, or alternative medical therapies challenging, thus underscoring the need for novel medical therapies or treatment regimens that target these lesions.

Abbreviations used in this paper: cAMP = cyclic adenosine monophosphate; DARP = dopamine agonist–resistant prolactinoma; NGF = nerve growth factor; NGFR = NGF receptor; SSTR = somatostatin receptor.

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Contributor Notes

Address correspondence to: Manish K. Aghi, M.D., Ph.D., The California Center for Pituitary Disorders, University of California, San Francisco, 505 Parnassus Avenue, Room M779, San Francisco, California 94143-0112. email: AghiM@neurosurg.ucsf.edu.

Please include this information when citing this paper: published online January 7, 2011; DOI: 10.3171/2010.11.JNS101369.

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