Advances in drug treatments for male patients with prolactinomas.

in Neuroendocrinology by Da Peng Wang, Han Yang Zhou, Yan Zhang, Li Xue, Zhe Bao Wu

TLDR

  • The study reviews recent advancements in understanding medical treatments and management approaches for male prolactinoma patients, with a focus on sex disparities and therapeutic options.
  • Men with prolactinomas are more prone to dopamine agonist resistance and may benefit from alternative therapies, but further research is needed to evaluate their effectiveness.

Abstract

Pituitary adenomas (PAs), the most common intracranial neuroendocrine tumors, are generally benign. Prolactinomas, which secrete prolactin, represent approximately 60% of all PAs and are characterized by hyperprolactinemia and the potential for mass effects. Significant differences exist between male and female prolactinoma patients in terms of epidemiology and clinical characteristics. Prolactinomas in male patients are often large and aggressive, posing unique challenges for treatment and management. While dopamine agonists (DAs) are the traditional first-line therapy for prolactinomas, men are more prone to DA resistance than women. Alternative therapeutic options for refractory prolactinomas in men include temozolomide (TMZ), immune checkpoint inhibitors (anti-PD1/PD-L1 and anti-CTLA4), somatostatin receptor analogs, mTOR inhibitors, tyrosine kinase inhibitors, bevacizumab, and aromatase inhibitors. These treatments may offer greater benefit to men with refractory prolactinomas compared to women. Despite progress, significant opportunities and challenges remain for treating male prolactinomas patients. These include early diagnosis, predicting drug sensitivity, understanding gender-driven molecular mechanisms, and developing novel therapeutic strategies. Large-scale clinical trials are essential to further evaluate the efficacy and safety of these therapies in men with prolactinomas. This review summarizes recent advancements in understanding medical treatments and management approaches for male prolactinoma patients.

Overview

  • The study focuses on prolactinomas in male patients, which are often large and aggressive, making treatment and management challenging.
  • The study discusses the significance of sex disparities in prolactinoma epidemiology and clinical characteristics, and how male patients are more prone to dopamine agonist resistance.
  • The primary objective of the study is to summarize recent advancements in understanding medical treatments and management approaches for male prolactinoma patients.

Comparative Analysis & Findings

  • The study finds that men with prolactinomas are more likely to be resistant to dopamine agonists, a traditional first-line therapy, compared to women.
  • Alternative therapeutic options for refractory prolactinomas in men include temozolomide, immune checkpoint inhibitors, somatostatin receptor analogs, mTOR inhibitors, tyrosine kinase inhibitors, bevacizumab, and aromatase inhibitors.
  • These treatments may offer greater benefit to men with refractory prolactinomas compared to women, but further research is needed to evaluate their efficacy and safety.

Implications and Future Directions

  • Early diagnosis, predicting drug sensitivity, understanding gender-driven molecular mechanisms, and developing novel therapeutic strategies are key opportunities and challenges for treating male prolactinoma patients.
  • Large-scale clinical trials are essential to further evaluate the efficacy and safety of alternative therapeutic options in men with prolactinomas.
  • Understanding sex disparities in prolactinoma epidemiology and clinical characteristics can inform the development of more effective and gender-specific treatment strategies.
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