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Management of prolactinomas: a survey of physicians from the Middle East and North Africa

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Abstract

Background

Prolactinomas are the commonest functional tumors of the pituitary gland. There are still controversies regarding medical therapy in specific clinical situations. Patients may be managed by different specialists in the Middle East and North Africa (MENA) region and no data exist on patterns of clinical management.

Objectives

To ascertain the diagnostic and therapeutic approaches to prolactinomas among relevant professionals from the MENA region.

Methods

An online survey of a large sample of physicians was conducted. The questionnaire covered various aspects of diagnosis and treatment of prolactinomas. 468 respondents were included; 36 % were endocrinologists; 49 % worked in public facilities and 81 % graduated more than 10 years. 40 and 30 % would have seen 1–5 and more than 5 suspected or confirmed prolactinomas over a 6 months period, respectively.

Results

Regarding the diagnosis, 30 % of the respondents considered that prolactin levels <100 ng/ml exclude the presence of a prolactinoma. 21 % of respondents considered prolactin levels >250 ng/ml compatible with macroprolactinomas only, whereas others accepted this to be compatible also with microprolactinomas, macroprolactinaemia and drug-induced hyperprolactinemia (50, 42 and 36 % respectively). 71 % of respondents favored the screening for macroprolactin in asymptomatic individuals with hyperprolactinemia. Regarding the treatment, 84 % of respondents would treat microprolactinomas even in the absence of symptoms whereas 72 % of the respondents would treat microprolactinomas only if symptoms exist. 60 and 49 % of the respondents chose cabergoline as the drug of choice to treat macroprolactinomas and microprolactinomas respectively. Similar proportions had no preference of either cabergoline or bromocriptine as the best treatment for macroprolactinoma (27 %) and microprolactinomas (32 %). 46 and 75 % of respondents favored treatment withdrawal 2–3 years after prolactin normalization in patients with macroprolactinomas and microprolactinomas, respectively whereas 10 % of respondents withdraw treatment after menopause in either case. 94 % of respondents considered medical therapy as the primary treatment for microprolactinomas. In case of pregnancy, 49 % considered bromocriptine as the drug of choice for women who wish to become pregnant. 65 and 38 % of respondents advocated discontinuation of treatment with dopamine agonists in patients with microprolactinomas and macroprolactinomas, respectively. Finally, 48 % would allow breast-feeding without restriction, 28 % would restrict it to patients with microprolactinomas and 25 % would not recommend it for women with prolactinomas.

Conclusions

This is the first study of the clinical management of prolactinomas in the MENA region. Some of the practices are not in line with the latest Endocrine and Pituitary Societies guidelines. These warrant further discussions of contemporary guidelines in regional forums.

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Acknowledgments

The authors would like to express their gratitude for all respondents who shared their expertise and opinions by participating in the survey.

Authors’ contribution

SAB adapted and conducted the electronic aspects of the survey. All others contributed to the manuscript and approved its final version.

Funding

This study received no funding whatsoever.

Author information

Authors and Affiliations

  1. Center for Diabetes and Endocrinology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates

    Salem A. Beshyah

  2. Al Afia Clinic, Tripoli, Libya

    Ibrahim H. Sherif

  3. Bab El Oued Hospital, Algiers, Algeria

    Farida Chentli

  4. Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates

    Amir Hamrahian

  5. Imperial College London Diabetes Center, Abu Dhabi, United Arab Emirates

    Aly B. Khalil

  6. King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia

    Hussein Raef

  7. University of Alexandria, Alexandria, Egypt

    Mohamed El-Fikki

  8. Saint-Joseph University, Beirut, Lebanon

    Selim Jambart

Authors
  1. Salem A. Beshyah
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  2. Ibrahim H. Sherif
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  3. Farida Chentli
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  4. Amir Hamrahian
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  5. Aly B. Khalil
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  6. Hussein Raef
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  7. Mohamed El-Fikki
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  8. Selim Jambart
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Corresponding author

Correspondence to Salem A. Beshyah.

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Conflict of interest

Salem A. Beshyah has received research grants from Novo Nordisk, Eli Lilly, Sanofi and Merck (MSD) and has received speaker’s honoraria from Novartis, Servier, Abbotts, Merck Serono and Boehringer Ingelheim for subjects unrelated to this research. Ibrahim H. Sherif , Farida Chentli, Amir Hamrahian, Aly B. Khalil, Hussein Raef, Mohamed El-Fikki and Selim Jambart declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors. All participants provided an informed explicit consent to participate electronically before they proceed to participation in the survey. All data are collected anonymously.

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Beshyah, S.A., Sherif, I.H., Chentli, F. et al. Management of prolactinomas: a survey of physicians from the Middle East and North Africa. Pituitary 20, 231–240 (2017). https://doi.org/10.1007/s11102-016-0767-5

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  • DOI: https://doi.org/10.1007/s11102-016-0767-5

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