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Long-term outcome of multimodal therapy for giant prolactinomas

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Abstract

Giant prolactinomas are rare tumors characterized by their large size, compressive symptoms, and extremely high prolactin secretion. The aim of this study is to describe our experience with a series of 16 giant prolactinomas cases in terms of clinical presentation, therapeutic decisions, and final outcomes. Retrospective analysis of adult patients diagnosed with giant prolactinomas at the endocrine departments of three university tertiary hospitals. We included 16 patients (43.7 % women); mean age at diagnosis: 42.1 ± 21 years. The most frequent presentation was compressive symptoms. The delay in diagnosis was higher in women (median of 150 months vs. 12 in men; p = 0.09). The mean maximum tumor diameter at diagnosis was 56.9 ± 15.5 mm, and mean prolactin levels were 10,995.9 ± 12,157.8 ng/mL. Dopamine agonists were the first-line treatment in 11 patients (mean maximum dose: 3.9 ± 3.2 mg/week). Surgery was the initial treatment in five patients and the second-line treatment in six. Radiotherapy was used in four cases. All patients but one, are still with dopamine agonists. After a mean follow-up of 9 years, prolactin normalized in 7/16 patients (43.7 %) and 13 patients (81 %) reached prolactin levels lower than twice the upper limit of normal. Mean prolactin level at last visit: 79.5 ± 143 ng/mL. Tumor volume was decreased by 93.8 ± 11.3 %, and final maximum tumor diameter was 18.4 ± 18.8 mm. Three patients are actually tumor free. Giant prolactinomas are characterized by a large tumor volume and extreme prolactin hypersecretion. Multimodal treatment is frequently required to obtain biochemical and tumor control.

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Authors and Affiliations

  1. Endocrinology Division, Complejo Hospitalario Universitario de Ourense (CHUO)—SERGAS, Ourense, 32005, Spain

    Paula Andujar-Plata & Paula Álvarez-Vázquez

  2. Complejo Asistencial Universitario de León (CAULE)—SACYL, León, 24008, Spain

    Rocio Villar-Taibo, Maria Dolores Ballesteros-Pomar, Alfonso Vidal-Casariego & Begoña Pérez-Corral

  3. Endocrinology Division, Complejo Hospitalario Universitario de Santiago de Compostela (CHUS)—SERGAS, Santiago de Compostela, 15706, Spain

    Jose Manuel Cabezas-Agrícola & Ignacio Bernabeu

  4. Neurosurgery Division, Complejo Hospitalario Universitario de Santiago de Compostela (CHUS)—SERGAS, Santiago de Compostela, 15706, Spain

    Ramón Serramito

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  1. Paula Andujar-Plata
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  2. Rocio Villar-Taibo
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  3. Maria Dolores Ballesteros-Pomar
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  9. Ignacio Bernabeu
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Correspondence to Ignacio Bernabeu.

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Andujar-Plata, P., Villar-Taibo, R., Ballesteros-Pomar, M.D. et al. Long-term outcome of multimodal therapy for giant prolactinomas. Endocrine 55, 231–238 (2017). https://doi.org/10.1007/s12020-016-1129-9

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