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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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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.


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.


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.


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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Correspondence to Ilan Shimon.

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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).

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