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The implicated mechanisms are not clearly defined. Management can be challenging and requires a multidisciplinary approach. In DA resistant prolactinomas, switching to another DA could be the first option to consider. Further strategies include surgery and radiotherapy used alone or in combination. In cases of aggressive or malignant prolactinomas, temozolomide could be offered. Immune checkpoint inhibitors have been also recently proposed as an alternative approach. The place of other treatments (e.g., metformin, selective estrogen modulators, somatostatin analogues, tyrosine kinase inhibitors, inhibitors of mammalian target of rapamycin and peptide radio-receptor therapy) remains to be carefully assessed.<\/jats:p>","DOI":"10.1007\/s11102-023-01305-8","type":"journal-article","created":{"date-parts":[[2023,3,26]],"date-time":"2023-03-26T23:46:40Z","timestamp":1679874400000},"page":"273-277","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Refractory lactotroph adenomas"],"prefix":"10.1007","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4056-2262","authenticated-orcid":false,"given":"Sandrine A.","family":"Urwyler","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4696-0643","authenticated-orcid":false,"given":"Niki","family":"Karavitaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,3,16]]},"reference":[{"issue":"2","key":"1305_CR1","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1210\/jc.2010-1692","volume":"96","author":"S Melmed","year":"2011","unstructured":"Melmed S et al (2011) Diagnosis and treatment of hyperprolactinemia: an endocrine Society clinical practice guideline. 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