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Tumour fibrosis in dopamine agonist-exposed prolactinomas is a diminishing concern

Nature Reviews Endocrinology volume 20, page 314 (2024)Cite this article

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We applaud the Pituitary Society on the latest prolactinoma Consensus Statement (Petersenn, S. et al. Diagnosis and management of prolactin-secreting pituitary adenomas: a Pituitary Society international Consensus Statement. Nat. Rev. Endocrinol. 19, 722–740 (2023)1), which highlights rare but serious dopamine agonist-related toxicities, such as impulse control disorders, as we demonstrated in a large cross-sectional study2. Accordingly, we support the increasing use of operative management in surgically accessible prolactinomas and have previously advocated for a low surgical threshold approach for prolactinomas3.

We question, however, the recommendation to routinely offer primary surgery to all patients with a microprolactinoma or a well-circumscribed macroprolactinoma (Knosp grade 0 or 1) before attempting cabergoline therapy. Although surgery can provide a definitive cure, a large subset of patients can be successfully treated by cabergoline without exposure to potentially permanent operative complications like hypopituitarism and meningitis3. Noting that dopamine agonist-induced toxicity is almost always reversible4, the recommendation for primary surgery before any attempt at cabergoline therapy seems to relate largely to concerns around the potential risk of dopamine agonist-induced tumour fibrosis.

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Authors and Affiliations

  1. Endocrine & Metabolic Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia

    Sunita M. C. De Sousa, Ian M. Chapman & David J. Torpy

  2. Department of Neurosurgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia

    Alistair K. Jukes, Nicholas G. Candy & Stephen Santoreneos

  3. Department of Neurosurgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia

    Brindha Shivalingam

  4. Otolaryngology Head & Neck Surgery, University of Adelaide, Adelaide, South Australia, Australia

    Peter-John Wormald

Authors
  1. Sunita M. C. De Sousa
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  2. Alistair K. Jukes
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Correspondence to Sunita M. C. De Sousa.

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De Sousa, S.M.C., Jukes, A.K., Candy, N.G. et al. Tumour fibrosis in dopamine agonist-exposed prolactinomas is a diminishing concern. Nat Rev Endocrinol 20, 314 (2024). https://doi.org/10.1038/s41574-024-00976-y

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