title: Management of prolactinomas: a survey of physicians from the Middle East and North Africa.
abstract: BACKGROUND
  Prolactinomas are the commonest functional tumors of the pituitary gland. There are still controversies regarding medical therapy in specific clinical situations. Patients may be managed by different specialists in the Middle East and North Africa (MENA) region and no data exist on patterns of clinical management.
  
  
  OBJECTIVE
  To ascertain the diagnostic and therapeutic approaches to prolactinomas among relevant professionals from the MENA region.
  
  
  METHODS
  An online survey of a large sample of physicians was conducted. The questionnaire covered various aspects of diagnosis and treatment of prolactinomas. 468 respondents were included; 36 % were endocrinologists; 49 % worked in public facilities and 81 % graduated more than 10 years. 40 and 30 % would have seen 1-5 and more than 5 suspected or confirmed prolactinomas over a 6 months period, respectively.
  
  
  RESULTS
  Regarding the diagnosis, 30 % of the respondents considered that prolactin levels <100 ng/ml exclude the presence of a prolactinoma. 21 % of respondents considered prolactin levels >250 ng/ml compatible with macroprolactinomas only, whereas others accepted this to be compatible also with microprolactinomas, macroprolactinaemia and drug-induced hyperprolactinemia (50, 42 and 36 % respectively). 71 % of respondents favored the screening for macroprolactin in asymptomatic individuals with hyperprolactinemia. Regarding the treatment, 84 % of respondents would treat microprolactinomas even in the absence of symptoms whereas 72 % of the respondents would treat microprolactinomas only if symptoms exist. 60 and 49 % of the respondents chose cabergoline as the drug of choice to treat macroprolactinomas and microprolactinomas respectively. Similar proportions had no preference of either cabergoline or bromocriptine as the best treatment for macroprolactinoma (27 %) and microprolactinomas (32 %). 46 and 75 % of respondents favored treatment withdrawal 2-3 years after prolactin normalization in patients with macroprolactinomas and microprolactinomas, respectively whereas 10 % of respondents withdraw treatment after menopause in either case. 94 % of respondents considered medical therapy as the primary treatment for microprolactinomas. In case of pregnancy, 49 % considered bromocriptine as the drug of choice for women who wish to become pregnant. 65 and 38 % of respondents advocated discontinuation of treatment with dopamine agonists in patients with microprolactinomas and macroprolactinomas, respectively. Finally, 48 % would allow breast-feeding without restriction, 28 % would restrict it to patients with microprolactinomas and 25 % would not recommend it for women with prolactinomas.
  
  
  CONCLUSIONS
  This is the first study of the clinical management of prolactinomas in the MENA region. Some of the practices are not in line with the latest Endocrine and Pituitary Societies guidelines. These warrant further discussions of contemporary guidelines in regional forums.
authors: Center for Diabetes and Endocrinology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates. beshyah@yahoo.com.
authors: Salem A
authors: SA
authors: Beshyah
authors: Al Afia Clinic, Tripoli, Libya.
authors: Ibrahim H
authors: IH
authors: Sherif
authors: Bab El Oued Hospital, Algiers, Algeria.
authors: Farida
authors: F
authors: Chentli
authors: Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
authors: Amir
authors: A
authors: Hamrahian
authors: Imperial College London Diabetes Center, Abu Dhabi, United Arab Emirates.
authors: Aly B
authors: AB
authors: Khalil
authors: King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
authors: Hussein
authors: H
authors: Raef
authors: University of Alexandria, Alexandria, Egypt.
authors: Mohamed
authors: M
authors: El-Fikki
authors: Saint-Joseph University, Beirut, Lebanon.
authors: Selim
authors: S
authors: Jambart
mesh_terms: D000328:Adult; D000352:Africa, Northern; D000077465:Cabergoline; D018491:Dopamine Agonists / Q000627:therapeutic use; D004873:Ergolines / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008877:Middle East; D010820:Physicians / Q000706:statistics & numerical data*; D010911:Pituitary Neoplasms / Q000188:drug therapy; D011247:Pregnancy; D011388:Prolactin / Q000378:metabolism; D015175:Prolactinoma / Q000188:drug therapy*; D011795:Surveys and Questionnaires
chemical_list: D018491:Dopamine Agonists; D004873:Ergolines; D011388:Prolactin; D000077465:Cabergoline
keywords: Hyperprolactinemia; MENA region; Pituitary tumors; Prolactin