PDF(Pubmed)
Abstract：
BACKGROUND: This guideline (GL) is aimed at providing a reference for the management of prolactin (PRL)-secreting pituitary adenoma in adults. However, pregnancy is not considered.
METHODS: This GL has been developed following the methods described in the Manual of the Italian National Guideline System. For each question, the panel appointed by Associazione Medici Endocrinologi (AME) has identified potentially relevant outcomes, which have then been rated for their impact on therapeutic choices. Only outcomes classified as \"critical\" and \"important\" have been considered in the systematic review of evidence and only those classified as \"critical\" have been considered in the formulation of recommendations.
RESULTS: The present GL provides recommendations regarding the role of pharmacological and neurosurgical treatment in the management of prolactinomas. We recommend cabergoline (Cab) vs. bromocriptine (Br) as the firstchoice pharmacological treatment to be employed at the minimal effective dose capable of achieving the regression of the 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, and 4) who are unwilling to undergo a chronic DA treatment. We recommend that patients with progressive disease notwithstanding previous tumor resection and ongoing DA should be managed by a multidisciplinary team with specific expertise in pituitary diseases using a multimodal approach that includes repeated surgery, radiotherapy, DA, and possibly, the use of temozolomide.
CONCLUSIONS: The present GL is directed to endocrinologists, neurosurgeons, and gynecologists working in hospitals, in territorial services or private practice, and to general practitioners and patients.
METHODS: This GL has been developed following the methods described in the Manual of the Italian National Guideline System. For each question, the panel appointed by Associazione Medici Endocrinologi (AME) has identified potentially relevant outcomes, which have then been rated for their impact on therapeutic choices. Only outcomes classified as \"critical\" and \"important\" have been considered in the systematic review of evidence and only those classified as \"critical\" have been considered in the formulation of recommendations.
RESULTS: The present GL provides recommendations regarding the role of pharmacological and neurosurgical treatment in the management of prolactinomas. We recommend cabergoline (Cab) vs. bromocriptine (Br) as the firstchoice pharmacological treatment to be employed at the minimal effective dose capable of achieving the regression of the 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, and 4) who are unwilling to undergo a chronic DA treatment. We recommend that patients with progressive disease notwithstanding previous tumor resection and ongoing DA should be managed by a multidisciplinary team with specific expertise in pituitary diseases using a multimodal approach that includes repeated surgery, radiotherapy, DA, and possibly, the use of temozolomide.
CONCLUSIONS: The present GL is directed to endocrinologists, neurosurgeons, and gynecologists working in hospitals, in territorial services or private practice, and to general practitioners and patients.
摘要：
背景：本指南（GL）旨在为成人泌乳素（PRL）分泌型垂体腺瘤的治疗提供参考。然而,怀孕是不考虑的。
方法：本GL是按照意大利国家指南系统手册中描述的方法开发的。对于每个问题,由Medici内分泌协会（AME）任命的小组已经确定了潜在的相关结果，然后根据它们对治疗选择的影响进行评级。只有分类为“关键”和“重要”的结果在证据的系统评价中被考虑，只有分类为“关键”的那些在建议的制定中被考虑。
结果：本GL提供了关于药物和神经外科治疗在泌乳素瘤治疗中的作用的建议。我们推荐卡麦角林（Cab）与溴隐亭（Br）作为首选药物治疗，以能够实现临床表现消退的最低有效剂量使用。我们建议为非侵入性PRL分泌腺瘤患者提供药物和手术作为合适的替代一线治疗。无论大小。我们建议将Br作为对Cab不耐受且不适合手术的患者的替代药物。我们建议对患者进行垂体瘤切除术1）从Cab开始的两周内没有任何显着的神经眼科改善，2）耐药或不耐受Cab或其他多巴胺激动剂药物（DA），3)逃避先前DA功效的人，和4)不愿意接受慢性DA治疗的人。我们建议，尽管先前进行过肿瘤切除和进行中的DA，但进行性疾病的患者应由具有垂体疾病专业知识的多学科团队使用包括重复手术在内的多模式方法进行管理。放射治疗,DA,而且可能,使用替莫唑胺。
结论：目前的GL是针对内分泌学家，神经外科医生,和妇科医生在医院工作，在领土服务或私人执业中，以及全科医生和患者。
方法：本GL是按照意大利国家指南系统手册中描述的方法开发的。对于每个问题,由Medici内分泌协会（AME）任命的小组已经确定了潜在的相关结果，然后根据它们对治疗选择的影响进行评级。只有分类为“关键”和“重要”的结果在证据的系统评价中被考虑，只有分类为“关键”的那些在建议的制定中被考虑。
结果：本GL提供了关于药物和神经外科治疗在泌乳素瘤治疗中的作用的建议。我们推荐卡麦角林（Cab）与溴隐亭（Br）作为首选药物治疗，以能够实现临床表现消退的最低有效剂量使用。我们建议为非侵入性PRL分泌腺瘤患者提供药物和手术作为合适的替代一线治疗。无论大小。我们建议将Br作为对Cab不耐受且不适合手术的患者的替代药物。我们建议对患者进行垂体瘤切除术1）从Cab开始的两周内没有任何显着的神经眼科改善，2）耐药或不耐受Cab或其他多巴胺激动剂药物（DA），3)逃避先前DA功效的人，和4)不愿意接受慢性DA治疗的人。我们建议，尽管先前进行过肿瘤切除和进行中的DA，但进行性疾病的患者应由具有垂体疾病专业知识的多学科团队使用包括重复手术在内的多模式方法进行管理。放射治疗,DA,而且可能,使用替莫唑胺。
结论：目前的GL是针对内分泌学家，神经外科医生,和妇科医生在医院工作，在领土服务或私人执业中，以及全科医生和患者。
