Overcoming therapy resistance in prolactinomas: from perspectives to real clinical practice
A. S. Shutova,
E. A. Pigarova,
L. I. Lepeshkina,
V. A. Ioutsi,
M. Yu. Drokov,
S. Y. Vorotnikova,
L. I. Astafyeva,
L. K. Dzeranova https://doi.org/10.14341/probl13351
Abstract
The main treatment option of prolactin-secreting pituitary adenomas is dopamine agonist therapy, which demonstrates prolactin level normalizing and reducing the size of an adenoma in the majority of cases. However, significant amount of patients — about 20% — poorly responds even to high doses of dopamine agonists that is explained by the resistance to therapy. The occurrence of pharmacodynamic characteristics is one of the causes responsible for the development of resistance to typical therapy. Clinical manifestations of persistent hyperprolactinemia are due to following pathological factors: hormonal hypersecretion and the mass-effect of pituitary adenoma. Prevention of irreversible changes is possible only with timely detection of resistance and determination of the optimal personalized treatment algorithm.
We report a clinical case of dopamine-agonist resistant microprolactinoma. Patient’s health stabilisation, normal level of prolactin and reduction in size of adenoma were achieved due to administration of combined treatment with tamoxifen and dopamine agonists. Hyperprolactinaemia occurring because of prolactin-secreting pituitary adenoma and associated adverse effects are significant problem, decreasing quality of life and demographics in general. This underlines the importance of figuring out causes and identifying predictors of the therapy resistance.The results of the study, illustrated by a clinical example, are presented in the present paper.
About the Authors
A. S. Shutova
Endocrinology Research Centre
Russian Federation
Competing Interests:
Russian Federation
Aleksandra S. Shutova
Moscow
Competing Interests:
none
E. A. Pigarova
Endocrinology Research Centre
Russian Federation
Competing Interests:
Russian Federation
Ekaterina A. Pigarova - MD, PhD.
Moscow
Competing Interests:
none
L. I. Lepeshkina
Peoples’ Friendship University of Russia named after Patrice Lumumba
Russian Federation
Competing Interests:
Russian Federation
Lyudmila I. Lepeshkina
Moscow
Competing Interests:
none
V. A. Ioutsi
Endocrinology Research Centre
Russian Federation
Competing Interests:
Russian Federation
Vitaliy A. Ioutsi - PhD.
Moscow
Competing Interests:
none
M. Yu. Drokov
National medical Research Center for Hematology
Russian Federation
Competing Interests:
Russian Federation
Mikhail Yu. Drokov
Moscow
Competing Interests:
none
S. Y. Vorotnikova
Endocrinology Research Centre
Russian Federation
Competing Interests:
Russian Federation
Svetlana Y. Vorotnikova – MD.
Moscow
Competing Interests:
none
L. I. Astafyeva
Burdenko Neurosurgical Institute
Russian Federation
Competing Interests:
Russian Federation
Liudmila I. Astafyeva – ScD.
Moscow
Competing Interests:
none
L. K. Dzeranova
National medical Research Center for Hematology
Russian Federation
Competing Interests:
Russian Federation
Larisa K. Dzeranova - MD, Sc.D.
Moscow
Competing Interests:
none
References
1. 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. doi: https://doi.org/10.1210/jc.2010-1692
2. Colao A. The prolactinoma. Best Pract Res Clin Endocrinol Metab. 2009;23(5):575-596. doi: https://doi.org/10.1016/j.beem.2009.05.003
3. Kalmykova ZA, Vorotnikova SY, Fedorova NS, et al. The efficacy of high-dose cabergoline treatment of prolactinomas resistant to standard doses: a clinical observation. Obesity and metabolism. 2019;16(2):89-94. (In Russ.)] doi: https://doi.org/10.14341/omet10243
4. Colao A., Savastano S. Medical treatment of prolactinomas. Nat Rev Endocrinol. 2011;7(5):267-278. doi: https://doi.org/10.1038/nrendo.2011.37
5. Su Y-X, Du G-L, Shen H-L, et al. Increased expression of aromatase cytochrome P450 enzyme is associated with prolactinoma invasiveness in post-menopausal women. J Int Med Res. 2019;47(7):3115-3126. doi: https://doi.org/10.1177/0300060519848916
6. Fedorova NS, Abrosimov AY, Dzeranova LK, et al. Pituitary lactotroph adenomas resistant to dopamine agonist treatment: histological and immunohistochemical characteristics. Arkh Patol. 2018;80(3):34-39. (In Russ.). doi: https://doi.org/10.17116/patol201880334-39
7. Fedorova NS, Dzeranova LK, Pigarova EA, et al. Tamoxifen in patients with dopamine agonist-resistant prolactinomas. Problems of Endocrinology. 2017;63(5):291-298. (In Russ.). doi: https://doi.org/10.14341/probl2017635291-298
8. Szmygin H, Szydełko J, Matyjaszek-Matuszek B. Dopamine agonist-resistant microprolactinoma — mechanisms, predictors and management: A case report and literature review. JCM. 2022;11(11):3070. doi: https://doi.org/10.3390/jcm11113070
9. Ciccarelli A., Daly A. F., Beckers A. The epidemiology of prolactinomas. Pituitary. 2005;8(1):3-6. doi: https://doi.org/10.1007/s11102-005-5079-0
10. Colao A., Lombardi G. Growth-hormone and prolactin excess. The Lancet. 1998;352(9138):1455-1461. doi: https://doi.org/10.1016/S0140-6736(98)03356-X
11. Dedov II, Mel’nichenko GA, Romancova TI, et al. Giperprolaktinemiya. Sovremennye podhody i starye problem. Bulletin of Reproductive Health. 2009;(2):2-8. (In Russ.).
12. Mel’nichenko GA, Dzeranova LK, Barmina II, et al. Rezistentnost’ k terapii agonistami dofamina u patsientov s giperprolaktinemiey. Bulletin of Reproductive Health. 2007;(1):33-41. (In Russ.) doi: https://doi.org/10.14341/brh2007133-41
13. Christian ZK, Hatanpaa KJ, Auchus RJ, et al. Dopamine agonist and tamoxifen combination therapy for a prolactin-secreting pituitary tumor resistant to dopamine agonist monotherapy: Case report and review. Interdiscip Neurosurg. 2020;21(3):100777. doi: https://doi.org/10.1016/j.inat.2020.100777
14. Gillam MP, Molitch ME, Lombardi G, Colao A. Advances in the treatment of prolactinomas. Endocr Rev. 2006;27(5):485-534. doi: https://doi.org/10.1210/er.2005-9998
15. López JM, Oestreicher E. Reversal of hypogonadotropic hypogonadism with tamoxifen in a patient with hyperprolactinemia resistant to dopamine agonists. Fertil Steril. 2005;84(3):756.e11-756.e14. doi: https://doi.org/10.1016/j.fertnstert.2005.05.006
16. Olafsdottir A, Schlechte J. Management of resistant prolactinomas. Nat Clin Pract Endocrinol Metab. 2006;2(10):552-561. doi: https://doi.org/10.1038/ncpendmet0290
17. Bykanova NS., Pigarova EA., Dzeranova LK. Prospects for the use of selective estrogen receptor modulator tamoxifen. Obesity and metabolism. 2012;9(1):9-13. (In Russ.). doi: https://doi.org/10.14341/2071-8713-5049
18. Jones ME, van Leeuwen FE, Hoogendoorn WE, et al. Endometrial cancer survival after breast cancer in relation to tamoxifen treatment: Pooled results from three countries. Breast Cancer Res. 2012;14(3):R91. doi: https://doi.org/10.1186/bcr3206
Supplementary files
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1. Figure 1. Metabolomic characteristics of patient N. | |
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2. Figure 2. Dynamics of changes in the level of prolactin in the blood serum of patient N. against the background of combination therapy. | |
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For citations:
Shutova A.S., Pigarova E.A., Lepeshkina L.I., Ioutsi V.A., Drokov M.Yu., Vorotnikova S.Y., Astafyeva L.I., Dzeranova L.K. Overcoming therapy resistance in prolactinomas: from perspectives to real clinical practice. Problems of Endocrinology. 2023;69(6):63-69. (In Russ.) https://doi.org/10.14341/probl13351
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