ECE2023 Poster Presentations Pituitary and Neuroendocrinology (123 abstracts)
Italian guidelines for the management of prolactinomas
Renato Cozzi 1 , Renata Simona Auriemma 2 , Ernesto Pasquale De Menis 3 , Felice Esposito 4 , Emanuele Ferrante 5 , Giuseppe Iatì 6 , Diego Mazzatenta 7 , Maurizio Poggi 8 , Roberta Rudà 9 , Fabio Tortora 10 , Fabio Cruciani 11 , Zuzana Mitrova 11 , Rosella Saulle 11 , Simona Vecchi 11 , Michele Basile 12 , Paolo Cappabianca 13 , Agostino Paoletta 14 , Enrico Papini 15,16 , Agnese Persichetti 17 , Irene Samperi 18 , Alessandro Scoppola 19 , Alessandro Bozzao 20 , Marco Caputo 21 , Francesco Doglietto 12 , Francesco Ferraù 22 , Andrea Lania 23 , Stefano Laureti 24 , Stefano Lello 25 , Davide Locatelli 26 , Pietro Maffei 27 , Giuseppe Minniti 28 , Alessandro Peri 29 , Chiara Ruini 30 , Fabio Settanni 31 , Antonio Silvani 32 , Nadia Veronese 1 , Franco Grimaldi 33 & Roberto Attanasio 34
1ASST Grande Ospedale Metropolitano Niguarda, Endocrinology, Milan, Italy; 2“Federico II’ University of Naples, Departments of Molecular and Clinical Endocrinology and Oncology, Naples, Italy; 3Treviso Hospital, Internal Medicine 2, Functional Department of Endocrinology and Metabolism, Treviso, Italy; 4University of Messina, Division of Neurosurgery, Messina, Italy; 5Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Endocrinology Unit, Milan, Italy; 6University of Messina, Radiation Oncology, Messina, Italy; 7University of Bologna, IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Biomedical and NeuroMotor Sciences (DIBINEM), Programma Neurochirurgia Ipofisi - Pituitary Unit, Bologna, Italy; 8S. Andrea Hospital, Sapienza University of Rome, Endocrinology, Department of Clinical and Molecular Medicine, Rome, Italy; 9Castelfranco Veneto and Treviso Hospital. University of Turin, Division of Neuro-Oncology, Department of Neuroscience “Rita Levi Montalcini”, Treviso, Italy; 10University “Federico II”, Naples, Radiology Unit, Department of Advanced Biomedical Sciences, Naples, Italy; 11Lazio Region Health Service, Epidemiology, Rome, Italy; 12Catholic University of Sacred Heart School of Medicine, Institute of Neurosurgery, Rome, Italy; 13’Federico II’ University of Naples, Neurosurgical Clinic, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Naples, Italy; 14ULSS6 Euganea, Padova, Italy; 15Ospedale Regina Apostolorum, Endocrinology, Albano Laziale (RM), Italy; 16Regina Apostolorum Hospital, Endocrinology and Metabolism, Italy; 17Ministry of Interior, Department of Firefighters, Public Rescue and Civil Defense, Rome, Italy; 18ASL Novara, Endocrinology, Novara, Italy; 19Ospedale Santo Spirito, Endocrinology, Rome, Italy; 20S. Andrea Hospital. Sapienza University of Rome, Neuroradiology. NESMOS Department (Neuroscience, Mental Health, Sensorial Organs), Rome, Italy; 21Synlab SRL, Laboratorio Analisi Cliniche e Microbiologia, Calenzano (FI), Italy; 22San Vincenzo Hospital, Medical Oncology Department, Taormina (ME), Italy; 23Humanitas Clinical and Research Center IRCCS, Humanitas University, Department of Biomedical Sciences, Endocrinology Unit, Rozzano (MI), Italy; 24USL Umbria 1, Perugia, Italy; 25Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Department of Woman and Child Health and Public Health, Institute of Obstetrics and Gynecology, Rome, Italy; 26University of Insubria, ASST Sette Laghi, Division of Neurosurgery, Department of Biotechnology and Life Sciences, Varese, Italy; 27Padua University, Department of Medicine (DIMED), 3rd Medical Clinic, Padua, Italy; 28University of Siena, Department of Medicine, Surgery and Neurosciences, Siena, Italy; 29University of Florence, Pituitary Diseases and Sodium Alterations Unit, Endocrinology, AOU Careggi, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, Florence, Italy; 30University of Bologna, Department of Psychology, Bologna, Italy; 31University of Turin, Clinical Biochemistry Laboratory, City of Health and Science University Hospital, Turin, Italy; 32Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Neuro-Oncology, Milan, Italy; 33Associazione Medici Endocrinologi, Past President, Udine, Italy; 34Associazione Medici Endocrinologi, Scientific Committee, Milano, Italy
Aim: This guideline (GL) is aimed at providing a reference for the management of prolactin (PRL)-secreting pituitary adenoma in non-pregnant adults.
Methods: For each question, the panel identified potentially relevant outcomes, which were then rated for their impact on therapeutic choices.
Results: The present GL provides recommendations about the roles of pharmacological and neurosurgical treatment for the management of prolactinomas. We recommend cabergoline (Cab) vs bromocriptine (Br) as the first-choice pharmacological treatment, to be employed at the minimal effective dose capable of achieving the regression of clinical picture. We suggest that medication and surgery are offered as suitable alternative first-line treatments to patients with non-invasive PRL-secreting adenoma, regardless of size. We suggest Br as an alternative drug in patients who are intolerant to Cab and are not candidates for surgery. We recommend pituitary tumor resection in patients 1) Without any significant neuro-ophthalmologic improvement within two weeks from the start of Cab, 2) Who are resistant or do not tolerate Cab (or other dopamine-agonist drugs, DA), 3) Who escape from previous efficacy of DA, 4) Unwilling to assume a chronic DA treatment. We recommend that patients with progressive disease notwithstanding previous tumor resection and ongoing DA should be managed in a multidisciplinary team with specific expertise in pituitary diseases with a multimodal approach that includes repeated surgery, radiotherapy, DA, and, possibly, temozolomide.
Conclusions: The present GL is directed to endocrinologists, neurosurgeons, and gynecologists working in hospitals, in territorial services or in private practice, and to general practitioners and patients.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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