| Abstract [eng] |
A macroprolactinoma is a pituitary tumor greater than or equal to 1 centimeter in size that secretes excessive amounts of prolactin. Macroprolactinomas cause a wide range of symptoms resulting from hormonal dysregulation and mass effect, including sexual dysfunction, infertility, headache, optic nerve damage. Although the diagnostic and therapeutic management of macroprolactinomas has been widely discussed in recent articles and by experts, problems of diagnosis and treatment errors remain relevant. Therefore, it is important to ensure timely diagnosis and appropriate treatment of macroprolactinomas in order to avoid the consequences of the disease. Aim of the study – is to review the latest scientific literature on the diagnosis and treatment strategies of macroprolactinomas and to evaluate the application of these strategies in practice by presenting clinical cases. Methods: Several methodologies were applied in this scientific study: a literature review and a clinical cases analysis. The literature search was performed in the electronic bibliographic medical database "PubMed", articles were selected based on their compliance with the inclusion criteria and relevance to the study topic. Results: Prolactin testing and pituitary magnetic resonance tomography play a key role in the diagnosis of macroprolactinomas. In laboratory diagnostics, it is essential to distinguish macroprolactinomas from macroprolactinemia: macroprolactin often mimics hyperprolactinemia but does not require further diagnostic evaluation or treatment unless monomeric prolactin is elevated. Polyethylene glycol precipitation optimizes diagnostic accuracy. Cabergoline is prescribed as the first-line treatment for macroprolactinomas, which normalizes prolactin levels and significantly reduces tumor size. Drug intolerance, resistance may require dose escalation, switching to other dopamine agonists or considering surgical, radiation therapy options. The analyzed clinical cases highlighted the importance of individualized treatment and monitoring in achieving remission of macroprolactinoma. Conclusions: The treatment of macroprolactinomas remains challenging due to the diverse manifestations of the disease, drug resistance and medication intolerance. Therefore, it is important to further improve treatment methods and individualize treatment strategies in order to enhance patients’ quality of life and clinical outcomes. Keywords: macroprolactinoma; diagnosis; treatment. |
