New Alogrithm Improves Medical Decision-Making for Prolactinomas
Elevated serum prolactin – especially that above normal but below 125 ng/ml – can cause a diagnostic dilemma. While often caused by a prolactinoma, it can also be caused by another type of adenoma compressing the pituitary stalk or by pituitary hyperplasia or lymphocytic hypophysitis. These mimics all lead to higher prolactin levels, but differ in their primary treatment.
Prolactinomas can often be treated with dopamine agonist therapy, either as a stand-alone treatment or as a step before surgery to shrink the tumor. Large adenomas compressing the stalk typically do not respond to medications as a first-line treatment and require surgery. A new algorithm developed at the CCPD combines preoperative prolactin level, age, and tumor size to correctly classify over 90% of sellar masses associated with elevated prolactin levels.
Because all of these variables are routinely looked at during work-up for pituitary adenomas, this algorithm may be especially useful for patients deciding between medical and surgical therapy.
Read more: Cheng JS, Salinas R, Molinaro A, Chang EF, Kunwar S, Blevins L, Aghi MK. A predictive algorithim for evaluating serum prolactin in patients with a sellar mass. J Clin Neurosci 2015;22(1): 155-60.
The Best Management Strategies for Patients with Persistent Cushing’s Disease
Although surgery is curative for a majority of patients with Cushing’s disease, a subset of patients continue to suffer from hypercortisolemia or experience a recurrence of the condition even years after surgery. This review delves into some of the clinical and surgical predictors of recurrence, and concludes that measuring serum cortisol levels the day after surgery can give a good indication of chances for long-term remission versus recurrence.