Prolactinomas and menopause: any changes in management?
- 12 Downloads
Treatment goals in prolactinomas are to correct hypogonadism, restore fertility and control tumor mass in case of macroadenomas. According to current guidelines, medical treatment of asymptomatic postmenopausal women is not indicated. The purpose of this study was to review the current literature pertaining to biological behavior of prolactinomas during menopause, likelihood of successful dopamine agonist withdrawal during this period and possible prolactin-mediated increased morbidity that could modify current management.
A comprehensive literature search including papers published until July 2019 was conducted using PubMed and Medline databases.
Women with prolactinomas entering menopause have a higher chance of prolactin normalization of treatment compared with women in their reproductive years. Although most prolactin secreting adenomas diagnosed during menopause are large, they respond well to dopamine agonist treatment. Data directly linking hyperprolactinemia with an increased risk of cancer and cardiovascular and metabolic morbidity are inconsistent. There is no data indicating that correction of hyperprolactinemia improves clinical outcomes in asymptomatic patients bearing microadenomas.
There is no evidence that justifies changing current recommendations to withhold medical treatment of microprolactinomas in asymptomatic post-menopausal women. Macroprolactinoma patients should be treated according to standard clinical practice.
KeywordsProlactin Pituitary adenoma Prolactinoma Menopause Osteoporosis Breast cancer
There was no funding for this paper.
Compliance with Ethical Standards
Conflict of interest
Yona Greenman declares that she has no conflict of interest.
Research involving animal and human participants
This article does not contain any studies with human participants or animals performed by any of the authors.
- 3.Agustsson TT, Baldvinsdottir T, Jonasson JG, Olafsdottir E, Steinthorsdottir V, Sigurdsson G, Thorsson AV, Carroll PV, Korbonits M, Benediktsson R (2015) The epidemiology of pituitary adenomas in Iceland, 1955–2012: a nationwide population-based study. Eur J Endocrinol 173:655–664CrossRefPubMedPubMedCentralGoogle Scholar
- 7.Kalleinen N, Polo-Kantola P, Irjala K, Porkka-Heiskanen T, Vahlberg T, Virkki A, Polo O (2008) 24-hour serum levels of growth hormone, prolactin, and cortisol in pre- and postmenopausal women: the effect of combined estrogen and progestin treatment. J Clin Endocrinol Metab 93(5):1655–1661CrossRefPubMedPubMedCentralGoogle Scholar
- 21.Reyes FI, Winter JS, Faiman CI (1977) Pituitary-ovarian relationships preceding the menopause. A cross-sectional study of serum follice-stimulating hormone, luteinizing hormone, prolactin, estradiol, and progesterone levels. Am J Obstet Gynecol 129(5): 557–564.Google Scholar
- 23.Mallea-Gil MS, Manavela M, Alfieri A, Ballarino MC, Chervin A, Danilowicz K, Diez S, Fainstein Day P, García-Basavilbaso N, Glerean M, Guitelman M, Katz D, Loto MG, Martinez M, Miragaya K, Moncet D, Rogozinski AS, Servidio M, Stalldecker G, Vitale M, Boero L (2016) Prolactinomas: evolution after menopause. Arch Endocrinol Metab 60(1):42–46CrossRefGoogle Scholar
- 41.Stuijver DJ, Debeij J, van Zaane B, Dekkers OM, Smit JW, Büller HR, Rosendaal FR, Gerdes VE, Cannegieter SC (2012) Levels of prolactin in relation to coagulation factors and risk of venous thrombosis* Results of a large population-based case-control study (MEGA-study). Thromb Haemost 108(3):499–507PubMedGoogle Scholar
- 43.Mon SY, Alkabbani A, Hamrahian A, Thorton JN, Kennedy L, Weil R, Olansky L, Doshi K, Makin V, Hatipoglu B (2013) Risk of thromboembolic events in patients with prolactinomas compared with patients with nonfunctional pituitary adenomas. Pituitary 16(4):523–527CrossRefPubMedPubMedCentralGoogle Scholar
- 47.Reuwer AQ, Twickler MT, Hutten BA, Molema FW, Wareham NJ, Dallinga-Thie GM, Bogorad RL, Goffin V, Smink-Bol M, Kastelein JJ, Boekholdt SM, Khaw KT (2009) Prolactin levels and the risk of future coronary artery disease in apparently healthy men and women. Circ Cardiovasc Genet 2(4):389–395CrossRefPubMedPubMedCentralGoogle Scholar