Giant prolactinomas larger than 60 mm in size: a cohort of massive and aggressive prolactin-secreting pituitary adenomas
Carregando...
Citações na Scopus
54
Tipo de produção
article
Data de publicação
2016
Título da Revista
ISSN da Revista
Título do Volume
Editora
SPRINGER
Autores
SHIMON, Ilan
SOSA, Ernesto
MENDOZA, Victoria
GREENMAN, Yona
TIROSH, Amit
ESPINOSA, Etual
POPOVIC, Vera
MERCADO, Moises
Citação
PITUITARY, v.19, n.4, p.429-436, 2016
Resumo
Prolactin (PRL)-secreting macroadenomas usually measure between 10 and 40 mm. Giant (adenoma size a parts per thousand yen40 mm) PRL-tumors are not common, and larger prolactinomas (maximal diameter a parts per thousand yen60 mm) are rare, and their management outcomes have not been well characterized. We have identified 18 subjects (16 men, 2 females) with giant PRL-adenomas (size a parts per thousand yen60 mm; PRL > 1000 ng/ml) and summarized their characteristics and response to treatment. Mean age was 36.3 +/- 13.5 years (range 12-59 years). Mean adenoma size was 71.8 +/- 10.2 mm (60-92 mm). Complaints at presentation included headaches in 11 patients, visual deterioration in 9, sexual dysfunction in 9 males, and behavioral changes in two. Fourteen (78 %) had visual field defects. Mean PRL at presentation was 28,465 ng/ml (range 1300-270,000). All patients were treated with cabergoline (3.9 +/- 2.0 mg/week), except for one who received bromocriptine. Treatment achieved PRL normalization in 11/18 patients within a median interval of 20 months. Visual improvement occurred in 12/14 patients with pre-treatment visual abnormalities. Nine patients underwent surgery (transsphenoidal, 7; transcranial, 2). None of the seven patients with elevated PRL before surgery achieved remission post-operatively. After a follow-up of 7.8 +/- 5.1 years, 15/18 patients had significant adenoma shrinkage. Eleven patients are normoprolactinemic, 3 are partially controlled (PRL < 3 x ULN), and 4 remain with significantly elevated PRL. Most patients reported disappearance or improvement of their complaints. These enormous PRL-adenomas are invasive but respond fairly well to medical treatment. Long-term therapy with high dose cabergoline together with a pituitary surgery in some patients was the key for their successful management, achieving biochemical and clinical remission in most patients.
Palavras-chave
Cabergoline, Giant, Pituitary adenoma, Prolactin, Prolactinoma
Referências
- BRISMAN MH, 1993, J NEUROSURG, V79, P135, DOI 10.3171/jns.1993.79.1.0135
- Colao A, 2004, J CLIN ENDOCR METAB, V89, P1704, DOI 10.1210/jc.2003-030979
- Colao A, 2003, EUR J ENDOCRINOL, V148, P325, DOI 10.1530/eje.0.1480325
- Corsello SM, 2003, CLIN ENDOCRINOL, V58, P662, DOI 10.1046/j.1365-2265.2003.01770.x
- Deepak D, 2007, CLIN ENDOCRINOL, V66, P503, DOI 10.1111/j.1365-2265.2007.02759.x
- Delgrange E, 2013, EUR J ENDOCRINOL, V170, P31
- Espinosa E, 2016, ENDOCRINE, V52, P652, DOI 10.1007/s12020-015-0791-7
- Gillam MP, 2006, ENDOCR REV, V27, P485, DOI 10.1210/er.2005-9998
- GREBE SKG, 1992, NEW ZEAL MED J, V105, P129
- Grozinsky-Glasberg S, 2011, PITUITARY, V14, P340, DOI 10.1007/s11102-008-0160-0
- Madsen H, 2011, AM J SURG PATHOL, V35, P1204, DOI 10.1097/PAS.0b013e31821e8c96
- Maiter D, 2014, EUR J ENDOCRINOL, V170, P213
- Shimon I, 2007, EUR J ENDOCRINOL, V156, P225, DOI 10.1530/EJE-06-0646
- Shrivastava RK, 2002, J NEUROSURG, V97, P299, DOI 10.3171/jns.2002.97.2.0299
- Tirosh A, 2016, MINERVA ENDOCRINOL
- Tirosh A, 2015, ENDOCR PRACT, V21, P1240, DOI 10.4158/EP15804.OR