Pituitary prolactinoma is the most common functioning pituitary adenoma in clinical practice. Hypogonadotropic hypogonadism secondary to hyperprolactinemia is the main clinical manifestation of patients. Most patients respond well to dopamine receptor agonists (DA). The patients with DA resistance and pituitary tumor apoplexy need neurosurgical treatment. Neurosurgery also increasingly applied to non-invasive microadenoma patients. Radiotherapy is an effective adjuvant treatment method. However, 10%-15% of prolactinoma patients develop refractory pituitary tumors and even progress to metastatic pituitary neuroendocrine tumors (pituitary cancer), seriously affecting the quality of life and even lifespan of patients. This article systematically reviews the definition evolution, molecular mechanism, early predictive markers, and the latest treatment progress of refractory pituitary prolactinoma. It is also suggested that the diagnosis and treatment level of refractory pituitary prolactinoma be gradually improved through the exploration and application of precision medicine and the promotion of standardized multidisciplinary collaborative diagnosis and treatment models.
垂体泌乳素腺瘤是临床最常见的功能性垂体腺瘤。高泌乳素血症导致的低促性腺激素型性腺功能减低是患者的主要临床表现。多数患者对多巴胺受体激动剂（DA）治疗反应良好，药物抵抗和垂体瘤卒中等泌乳素腺瘤患者需接受手术治疗，手术也越来越多地应用于非侵袭性的微腺瘤患者，放射治疗是有效的辅助治疗手段，但仍有10%~15%的泌乳素腺瘤患者发展为难治性垂体瘤，甚至进展为转移性垂体神经内分泌肿瘤（垂体癌），严重影响患者生活质量甚至寿命。本文系统总结了难治性垂体泌乳素腺瘤的定义演变、分子机制、早期预警指标以及最新治疗进展，并建议通过精准医学的探索应用以及规范化多学科协作诊疗模式的推广逐渐提高难治性垂体泌乳素腺瘤的诊治水平。.