Treatment of Multiple Endocrine Neoplasia Type 1 (MEN1) with Prolactinoma
Patients with MEN1 frequently develop pituitary adenomas, and prolactinoma is the most common pituitary subtype in this setting. Managing prolactinoma within the context of MEN1 requires a specific, evidence-informed approach.
Clinical Scenario
MEN1 with concurrent prolactinoma. Most pituitary adenomas in MEN1 are hormone-secreting; prolactinomas represent the predominant subtype, occurring in a substantial proportion of affected patients.
Treatment Approach
The protocol addresses prolactinoma in the MEN1 context and centres on a specific class of pharmacological therapy. Agent selection, sequencing, and the complete clinical algorithm are detailed in the full regimen.
References
Most pituitary adenomas in MEN1 are hormone-secreting (52–85%) and follow a similar distribution to sporadic pituitary adenomas, with prolactinomas being the most common subtype (43–79%), closely followed by clinically non-functioning pituitary adenomas (15–43%), somatotrophinomas (4–9%; gigantism or acromegaly), corticotrophinomas (1–4%; Cushing disease), and thyrotrophinomas (<1%).
Our systematic review revealed that dopamine agonist (eg, cabergoline, bromocriptine, or quinagolide) resistance in prolactinomas was not more common in patients with MEN1 than patients without MEN1, hence confirming that use of dopamine agonist for treatment of prolactinomas is appropriate in patients with MEN1, although the GRADE levels (scores) for this were very low.
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