Giant prolactinomas: clinical manifestations and outcomes of 16 Arab cases

Almalki, Mussa; Buhary, Badurudeen Mahmood; Alzahrani, Saad; Alshahrani, Fahad; Alsherbeni, Safia; Alhowsawi, Ghada; Aljohani, Naji

doi:10.1007/s11102-014-0588-3

Cited by 15 publications

(14 citation statements)

References 21 publications

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“…To date, a small number of series have evaluated patients with gPRLomas [4][5][6][7][8][11][12][13][14][15]. On the other hand, little is known about the differences in relation to the clinical features and therapeutic response in macroprolactinomas depending on their size.…”

Section: Introductionmentioning

confidence: 99%

Giant Prolactinoma in Men: Clinical Features and Therapeutic Outcomes

et al. 2018

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The aim of the study was to evaluate the clinical features and long-term therapeutic outcome of giant prolactinoma (gPRLoma) in men and to compare them with those of a group of male patients with non-gPRL macroprolactinomas (non-gPRLomas). A retrospective and multicenter study of gPRLomas in men diagnosed in a 20-year period was performed. Clinical data and treatment outcome were registered. The diagnosis of gPRLoma was established when the maximal tumor diameter was ≥40 mm or the tumor had ≥20 mm of suprasellar extension associated to hyperprolactinemia (PRL>1000 ng/ml). Non-gPRLoma was considered when tumor diameter was ≥ 10 mm and<40 mm associated to hyperprolactinemia (PRL≥200 ng/ml). Twenty-three patients with gPRLoma (age 38.3±13.5 years) followed for at least 3 months (follow-up 87.1±60.5 months, range 3–211 months) were evaluated. A group of 42 patients with non-gPRLoma (age 42±16.6 years; NS; follow-up 89±65.9 months, range 3–222 months; NS) served as a control group. More than half (56.5%) of the gPRLoma patients were younger than 40 years at diagnosis. Visual disturbances were significantly more common in gPRLoma than in non-gPRLoma patients (65.2 vs. 25.6%; p=0.004). Prevalence of hypopituitarism was similar in both groups of patients (73.9% vs. 80.9%; gPRLoma vs non-gPRLoma; NS). Serum PRL concentrations were significantly higher in gPRLoma than in non-gPRLoma patients [median (IR), 3978 ng/ml (1179–9012) vs. 907 ng/ml (428–3119); p<0.001]. Maximum tumor diameter in gPRLomas was 4.8±0.8 cm and 2.4±0.7 cm in non-gPRLoma (p<0.001). All patients were treated with dopamine agonists (DA). Twelve (52.2%) gPRLoma patients and 32 (73.8%) non-gPRLoma patients were treated with DA as monotherapy (p=0.045). Surgery was used in 12 (52.2%) gPRLoma patients and in 12 (28.6%) non-gPRLoma patients (p=0.054). Lastly, radiotherapy was used in 5 (21.7%) gPRLoma patients and in 6 (14.2%) non-gPRLoma patients (NS). At last visit, PRL was similar in both groups of patients [16 ng/ml (4–30) vs. 11 ng/ml (4–25); gPRLomas vs. non-gPRLomas; ns] and tumor size decreased significantly (p<0.001) in both groups of patients. Clinical cure (maintained normoprolactinemia without therapy for>1 year and no radiological evidence of pituitary tumor) was achieved in 2 (8.7%) gPRLoma patients and in 2 (4.8%) non-gPRLoma patients (NS). gPRLomas in men are usually diagnosed at a mean age of 40 years, an age similar to that of non-gPRLomas. The only clinical difference with non-gPRLomas is their greater prevalence of visual disturbances. The therapeutic approaches and tumor outcomes were similar to those obtained in patients with non-gPRLomas. Complete cure in gPRLoma is rare, but similar to that achieved in non-gPRLomas, reached in less than 10% of patients.

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Section: Introductionmentioning

confidence: 99%

Giant Prolactinoma in Men: Clinical Features and Therapeutic Outcomes

et al. 2018

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“…Dopamine agonists have been demonstrated as a first-line therapy for IGPs, because they can significantly shrink tumor volume and control the PRL levels [2, 10–12, 14, 18–25]. As for giant prolactinomas, the overall tumor response rate to DA treatment was 47%–87% [10, 11, 14, 19, 20, 22, 25].…”

Section: Discussionmentioning

confidence: 99%

Long-Term Clinical Outcomes of Invasive Giant Prolactinomas after a Mean Ten-Year Followup

Cai

Lin

et al. 2016

International Journal of Endocrinology

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Objective. The aim of this study is to observe clinical outcomes after more than ten years of followup in a group of patients with invasive giant prolactinomas (IGPs) treated with dopamine agonists (DAs). Methods. Twenty-five patients met the criteria of IGPs, among which 16 patients primarily received bromocriptine (BRC) and the other nine had undergone unsuccessful microsurgery prior to BRC treatment. Results. After a mean follow-up period of 135.5 ± 4.7 months, the clinical symptoms in all patients improved by different degrees. Tumor volume was decreased by a mean of 98.6%, and the tumors of 19 patients had almost completely disappeared. The mean duration of treatment at maximal doses of BRC was 48.5 months. At the last follow-up visit, nineteen patients had normal PRL levels, and 14 of these patients had received the low-dose BRC treatment (at an average of 2.9 ± 0.3 mg/d). Younger patients < 25 years had a significantly higher rate of persistent hyperprolactinemia after long-term BRC treatment (p = 0.043). Conclusion. DAs are a first-line therapy for IGPs because they can effectively achieve long-term control in both shrinking tumor volume and normalizing the PRL level, and majority of patients need low-dose DA maintenance. Younger patients are prone to persistent hyperprolactinemia despite long-term DA treatment.

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“…Prolactinomas are the most common type of pituitary adenoma and account for 30% of all clinically recognized cases of pituitary adenomas 1 . Generally, prolactinomas arise in the second to fourth decade of life and are more quickly recognized in women than in men because the women experience an abrupt cessation of menses 1 – 3 . In men, hyperprolactinemia (HPRL) causes hypogonadotropic hypogonadism leading to decreased libido, impotence, infertility, gynecomastia or galactorrhea 1 , 3 , 4 .…”

Section: Introductionmentioning

confidence: 99%

“…Generally, prolactinomas arise in the second to fourth decade of life and are more quickly recognized in women than in men because the women experience an abrupt cessation of menses 1 – 3 . In men, hyperprolactinemia (HPRL) causes hypogonadotropic hypogonadism leading to decreased libido, impotence, infertility, gynecomastia or galactorrhea 1 , 3 , 4 . This effect is due to prolactin’s inhibitory action on gonadotropin releasing hormone, which ultimately results in decreased luteinizing hormone levels and decreased testosterone production by the testes 1 , 2 , 4 .…”

Section: Introductionmentioning

confidence: 99%

Case Report: Persistent erectile dysfunction in a man with prolactinoma

et al. 2015

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Erectile dysfunction has been explored as a condition secondary to elevated prolactin; however, the mechanisms by which elevated prolactin levels cause erectile dysfunction have not yet been clearly established. We here present a patient with a history of prolactinoma who suffered from persistent erectile dysfunction despite testosterone supplementation and pharmacological and surgical treatment for the prolactinoma. Patients who have had both prolactinemia and erectile dysfunction have been reported in the literature, but we find no report of a patient with persistent erectile dysfunction in the setting of testosterone supplementation and persistent hyperprolactinemia refractory to treatment. This case provides evidence supporting the idea that suppression of erectile function occurs in both the central and peripheral nervous systems independent of the hypothalamic-pituitary-gonadal axis.

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Giant prolactinomas: clinical manifestations and outcomes of 16 Arab cases

Abstract: Findings indicate that cabergoline provides dramatic clinical improvements with excellent safety profile. Cabergoline should therefore be considered as the primary therapy for giant prolactinomas.

Cited by 15 publications

References 21 publications

Giant Prolactinoma in Men: Clinical Features and Therapeutic Outcomes

Giant Prolactinoma in Men: Clinical Features and Therapeutic Outcomes

Long-Term Clinical Outcomes of Invasive Giant Prolactinomas after a Mean Ten-Year Followup

Case Report: Persistent erectile dysfunction in a man with prolactinoma

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