Chief of the Neuroendocrine Unit, Endocrinology and Metabolism Division, Hosputal das Clinicas, Univeristy of Sao Paulo Medical School Hospital das Clinicas University of Sao Paulo Medical School
Approach to the Patient With Dopamine-Resistant Microprolactinoma Andrea Glezer, Matheo Augusto Morandi Stumpf, Nara Lima Queiroz Journal of Clinical Endocrinology and Metabolism, 2026 Prolactinoma is a significant cause of hyperprolactinemia and the most common type of pituitary tumor. Women of fertile age are most commonly affected, and the clinical picture is characterized by galactorrhea, oligo-amenorrhea, and infertility. In microprolactinomas, which represent more than 60% of cases in women before menopause, there is usually no concern about the mass effect. Therefore, management can be expectant if there are no symptoms or in a patient in the postmenopausal period; oral contraceptive in the presence of hypogonadism and no desire for pregnancy; dopamine agonist (DA) in the presence of bothersome galactorrhea, hypogonadism, and the desire for fertility; and neurosurgery in selected noninvasive cases. Resistance to DA occurs in less than 10% of cases. Although the reduction in dopamine receptor subtype 2 expression is considered the primary cause of DA resistance, the underlying mechanisms are not yet completely elucidated. The main concern in resistant cases is the risk of symptomatic tumor growth during assisted reproduction techniques and pregnancy. Other conditions in which hyperprolactinemia could be implicated, such as metabolic parameters, osteoporosis, and breast cancer risk are also discussed. Understanding the mechanisms of DA resistance can lead to the opening of new treatment strategies.
Hyperprolactinemia in women: diagnostic approach Andrea Glezer, Heraldo Mendes Garmes, Leandro Kasuki, Manoel Martins, Paula Condé Lamparelli Elias, et al. Revista Brasileira De Ginecologia E Obstetricia, 2024
Hyperprolactinemia in women: treatment Cristina Laguna Benetti-Pinto, Andrea Prestes Nácul, Ana Carolina Japur Rosa e Silva, Gustavo Arantes Rosa Maciel, Vania dos Santos Nunes Nogueira, et al. Revista Brasileira De Ginecologia E Obstetricia, 2024
Management of pituitary tumors in pregnancy Andrea Glezer, Raquel S. Jallad, Marcio C. Machado, Marcello D. Bronstein Pituitary Tumors A Comprehensive and Interdisciplinary Approach, 2021
Pituitary Physiology During Pregnancy and Lactation Raquel Soares Jallad, Andrea Glezer, Marcio Carlos Machado, Marcello D. Bronstein Maternal Fetal and Neonatal Endocrinology Physiology Pathophysiology and Clinical Management, 2020
Pituitary Disorders During Pregnancy and Lactation Raquel Soares Jallad, Andrea Glezer, Marcio Carlos Machado, Marcello D. Bronstein Maternal Fetal and Neonatal Endocrinology Physiology Pathophysiology and Clinical Management, 2020
Pituitary Disorders During Pregnancy and Lactation Raquel Soares Jallad, Andrea Glezer, Marcio Carlos Machado, Marcello D. Bronstein Maternal Fetal and Neonatal Endocrinology Physiology Pathophysiology and Clinical Management, 2019
Pituitary Physiology During Pregnancy and Lactation Raquel Soares Jallad, Andrea Glezer, Marcio Carlos Machado, Marcello D. Bronstein Maternal Fetal and Neonatal Endocrinology Physiology Pathophysiology and Clinical Management, 2019