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Giant prolactinomas larger than 60 mm in size: a cohort of massive and aggressive prolactin-secreting pituitary adenomas

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Abstract

Objectives

Prolactin (PRL)-secreting macroadenomas usually measure between 10 and 40 mm. Giant (adenoma size ≥40 mm) PRL-tumors are not common, and larger prolactinomas (maximal diameter ≥60 mm) are rare, and their management outcomes have not been well characterized.

Methods

We have identified 18 subjects (16 men, 2 females) with giant PRL-adenomas (size ≥60 mm; PRL > 1000 ng/ml) and summarized their characteristics and response to treatment.

Results

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 × ULN), and 4 remain with significantly elevated PRL. Most patients reported disappearance or improvement of their complaints.

Conclusions

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.

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References

  1. Colao A, Sarno AD, Cappabianca P, Briganti F, Pivonello R, Somma CD, Faggiano A, Biondi B, Lombardi G (2003) Gender differences in the prevalence, clinical features and response to cabergoline in hyperprolactinemia. Eur J Endocrinol 148:325–331

    Article  CAS  PubMed  Google Scholar 

  2. Gillman MP, Molitch ME, Lombardi G, Colao A (2006) Advances in the treatment of prolactinomas. Endocr Rev 27:485–534

    Article  Google Scholar 

  3. Maiter D, Delgrange E (2014) Therapy of endocrine disease: the challenges in managing giant prolactinomas. Eur. J. Endocrinol. 170 R:213–227

    Article  Google Scholar 

  4. Shrivastava RK, Arginteanu MS, King WA, Post KD (2002) Giant prolactinomas: clinical management and long-term follow up. J Neurosurg 97:299–306

    Article  PubMed  Google Scholar 

  5. Corsello SM, Ubertini G, Altomare M, Lovicu RM, Migneco MG, Rota CA, Colosimo C (2003) Giant prolactinomas in men: efficacy of cabergoline treatment. Clin Endocrinol (Oxf) 58:662–670

    Article  CAS  Google Scholar 

  6. Shimon I, Benbassat C, Hadani M (2007) Effectiveness of long-term cabergoline treatment for giant prolactinomas: study of 12 men. Eur J Endocrinol 156:225–231

    Article  CAS  PubMed  Google Scholar 

  7. Delgrange E, Raverot G, Bex M, Burman P, Decoudier B, Devuyst F, Feldt-Rasmussen U, Andersen M, Maiter D (2013) Giant prolactinomas in women. Eur J Endocrinol 170:31–38

    Article  PubMed  Google Scholar 

  8. Espinosa E, Sosa E, Mendoza V, Ramírez C, Melgar V, Mercado M (2016) Giant prolactinomas: are they really different from ordinary macroprolactinomas? Endocrine. doi:10.1007/s12020-015-0791-7

  9. Grozinsky-Glasberg S, Shimon I (2011) Unusual clinical presentations of giant prolactinomas. Pituitary 14:340–344

    Article  PubMed  Google Scholar 

  10. Grebe SK, Delahunt JW, Feek CM (1992) Treatment of extensively invasive (giant) prolactinomas with bromocriptine. N Z Med J 105:129–131

    CAS  PubMed  Google Scholar 

  11. Tirosh A, Shimon I (2016) Current approach to treatments for prolactinomas. Minerva Endocrinol [Epub ahead of print]

  12. Colao A, Vitale G, Cappabianca P, Briganti F, Ciccarelli A, De Rosa M, Zarrilli S, Lombardi G (2004) Outcome of cabergoline treatment in men with prolactinoma: effects of a 24-month treatment on prolactin levels, tumor mass, recovery of pituitary function, and semen analysis. J Clin Endocrinol Metab 89:1704–1711

    Article  CAS  PubMed  Google Scholar 

  13. Tirosh A, Benbassat C, Shimon I (2015) Short-term decline in prolactin concentrations can predict future prolactin normalization, tumor shrinkage, and time to remission in men with macroprolactinomas. Endocr Pract 21:1240–1247

    Article  PubMed  Google Scholar 

  14. Madsen H, Borges TM, Knox AJ, Michaelis KA, Xu M, Lillehei KO, Wierman ME, Kleinschmidt-DeMasters BK (2011) Giant pituitary adenomas: pathologic-radiographic correlations and lack of role for p53 and MIB-1 labeling. Am J Surg Pathol 35:1204–1213

    Article  PubMed  Google Scholar 

  15. Deepak D, Daousi C, Javadpour M, MacFarlane IA (2007) Macroprolactinomas and epilepsy. Clin Endocrinol (Oxf) 66:503–507

    Google Scholar 

  16. Brisman MH, Fetell MR, Post KD (1993) Reversible dementia due to macroprolactinoma. Case report. J Neurosurg 79:135–137

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.

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Correspondence to Ilan Shimon.

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Conflict of interest

Ilan Shimon, has received research grants, consulting and lectureship fees from Novartis and Pfizer. Yona Greenman received research grant from Pfizer, and research grant, travel support and speaker fees from Novartis. Marcello D. Bronstein, is speaker for Ipsen and Novartis, member of steering committees for Chiasma, Ipsen and Novartis. Moises Mercado is a consultant and lecturer for Novartis Oncology and Ipsen. Ernesto Sosa, Victoria Mendoza, Amit Tirosh, Etual Espinosa and Andrea Glezer have no conflicts of interest to declare.

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Shimon, I., Sosa, E., Mendoza, V. et al. Giant prolactinomas larger than 60 mm in size: a cohort of massive and aggressive prolactin-secreting pituitary adenomas. Pituitary 19, 429–436 (2016). https://doi.org/10.1007/s11102-016-0723-4

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  • DOI: https://doi.org/10.1007/s11102-016-0723-4

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