This protocol addresses the clinical scenario in which a prolactinoma macroadenoma has not been adequately controlled by medical therapy or surgery, and a further treatment step is required.
Macroadenoma that remains resistant after standard medical approaches or surgical intervention represents a specific escalation point. The protocol defines the criteria and approach for this situation.
When macroadenoma proves resistant to both medical therapy and surgery, radiotherapy — in any of its available forms — enters consideration as the next treatment step. The full protocol outlines how this option is applied and what to weigh before proceeding.
DOI: 10.1210/clinem/dgad174
Radiotherapy, in any form, is now considered a third-line treatment and is reserved for those patients with macroadenomas resistant to either medical therapy or surgery, as in clinical case 3, mainly because of the long latency to therapeutic efficacy and the frequent occurrence of hypopituitarism.
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