Long‐term response to cabergoline and multi‐modal treatment in men with macroprolactinoma: Does size really matter?

Rudman, Yaron; Duskin-Bitan, Hadar; Manisterski, Yossi; Pertzov, Barak; Akirov, Amit; Masri-Iraqi, Hiba; Shimon, Ilan

doi:10.1111/cen.14541

Cited by 9 publications

(8 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This study clearly shows that cabergoline (CAB) is superior to bromocriptine (BRC) in achieving the outcome which is comparable to previously published data. In a recent article by Rudman et al [16], macroprolactinomas in men were controlled with cabergoline in 84% of cases. In another retrospective comparison of CAB and BCR in hyperprolactinemia by Arduc et al [17], CAB was found more effective than BCR in controlling symptoms of hormone excess, normalization of PRL (87.4 vs. 41.4%) and tumor shrinkage (79.8 ± 39.1 vs. 54.1 ± 55.3%).…”

Section: Discussionmentioning

confidence: 98%

Prolactinoma: Clinical Characteristics, Management and Outcome

Irfan¹,

Shafiq²,

Siddiqi³

et al. 2022

Cureus

View full text Add to dashboard Cite

Prolactinoma, a prolactin (PRL) secreting functioning pituitary tumor, is the most common of all pituitary adenomas (PA) accounting for 40-60% and dopamine agonists (DA) are the cornerstone of treatment. The aim of this study was to review the clinical presentation, treatment modalities and therapeutic outcomes of patients with prolactinomas in the South Asia region. MethodsThis retrospective study was conducted in the Endocrinology Department of Shaukat Khanum Memorial Cancer Hospital and Research Centre from December 2011 till December 2019. Medical records were used to retrieve for patient's demographics, clinical features at diagnosis, PRL levels and size of prolactinoma on MRI at diagnosis and after start of dopamine agonists and outcome of medical management. ResultsA total of 107 patients were included in this study. Mean age at diagnosis was 35 (22-54) years for men and 32 (18-50) years for women and 66.4% (71) of the patients were females. Our study included 38 (35.5%) microadenoma, 50 (46.7%) macroadenoma and 19 (17.8%) giant adenomas. At presentation, the most common symptom among females was menstrual irregularity/amenorrhea seen in 73.2% of females and among males was visual disturbance (80.6%). A significant reduction in PRL levels was seen within six to 12 months of treatment. Mean PRL levels decreased from 3162.8 ng/ml to 1.52 ng/ml. A notable decrease in tumor size was seen with medical management, mean adenoma size decreased from 2.18 cm to 1.04 cm. With cabergoline (CAB) 83.3% biochemical cure was seen compared to bromocriptine (BRC) which has 60.4%. The radiological response rate in CAB and BRC groups was 65.45% and 60%, respectively. Complete resolution of adenoma was seen in 13 patients (nine were microadenoma, two macro and two giant adenomas). The prolactin level at diagnosis was positively correlated with maximum tumor diameter (r = 0.469, P = 0.001). Two patients developed cerebrospinal fluid (CSF) rhinorrhea and the defect was repaired in both patients. Median follow-up duration was 40 (12-288) months. ConclusionClinical presentation and demographics of prolactinoma are the same in our region when compared to the rest of the world. Cabergoline is superior to bromocriptine in prolactin normalization and tumor shrinkage but still bromocriptine is being used in a significant number of patients in low-income countries as first-line due to its low cost.

show abstract

Section: Discussionmentioning

confidence: 98%

Prolactinoma: Clinical Characteristics, Management and Outcome

Irfan¹,

Shafiq²,

Siddiqi³

et al. 2022

Cureus

View full text Add to dashboard Cite

show abstract

“…The difference in PRLomas size is already noticeable in children; tumors in boys are typically larger and more invasive than in girls (70 and 38%, respectively) but they are generally more frequent in girls (53)(54)(55)(56)(57). Up to 25% of male PRLomas are represented by giant PRLomas (gPRLomas) (24,31,58,59), defined as PRL-secreting PAs ≥ 4 cm in diameter, often associated with markedly high serum PRL levels and significant extrasellar extension (16,24). The incidence of gPRLomas is estimated at 0.5 to 4.4% of all PAs (60, 61).…”

Section: Epidemiologymentioning

confidence: 99%

“…In men, the diagnosis may be delayed due to unawareness of symptoms, their shaming nature for patients, or the timing of reporting to the physician since their onset (12-14, 19, 25, 26). In addition to the differences mentioned above, PRLomas in men also affect cardiovascular and metabolic risk (12,(27)(28)(29), semen quality and fertility potential (13, [30][31][32][33][34], bone health (12, 35,36), and increase in total body fat (29,37,38), making the role of hyperprolactinemia control essential in men's health.…”

Section: Introductionmentioning

confidence: 99%

Prolactin-secreting pituitary adenomas: male-specific differences in pathogenesis, clinical presentation and treatment

Dzialach,

Sobolewska,

Zak

et al. 2024

Front. Endocrinol.

View full text Add to dashboard Cite

Prolactinomas (PRLomas) constitute approximately half of all pituitary adenomas and approximately one-fifth of them are diagnosed in males. The clinical presentation of PRLomas results from direct prolactin (PRL) action, duration and severity of hyperprolactinemia, and tumor mass effect. Male PRLomas, compared to females, tend to be larger and more invasive, are associated with higher PRL concentration at diagnosis, present higher proliferative potential, are more frequently resistant to standard pharmacotherapy, and thus may require multimodal approach, including surgical resection, radiotherapy, and alternative medical agents. Therefore, the management of PRLomas in men is challenging in many cases. Additionally, hyperprolactinemia is associated with a significant negative impact on men’s health, including sexual function and fertility potential, bone health, cardiovascular and metabolic complications, leading to decreased quality of life. In this review, we highlight the differences in pathogenesis, clinical presentation and treatment of PRLomas concerning the male sex.

show abstract

“…The RMC pituitary clinic's treatment and follow-up protocol for this cohort of male macroprolactinoma is available in a previously published article [7].…”

Section: Treatment and Follow-up Protocolmentioning

confidence: 99%

Predicting hypogonadotropic hypogonadism persistence in male macroprolactinoma

Rudman¹,

Duskin-Bitan²,

Masri-Iraqi³

et al. 2022

EJEA

Self Cite

View full text Add to dashboard Cite

To study the baseline characteristics predicting hypogonadotropic hypogonadism (HH) persistence in men with macroprolactinoma that achieved prolactin normalization. Design:Retrospective cohort study. Methods:Male patients diagnosed with macroprolactinoma and HH that received cabergoline treatment with subsequent prolactin normalization were included: men that achieved eugonadism, and men that remained hypogonadal. Patient's demographic, clinical and biochemical parameters, sellar imaging and visual elds tests were obtained.Univariate and multivariate models were used to identify predictors of HH persistence. Results:Fifty-eight male patients (age, 49.2±12.6 years) with a median baseline prolactin of 1154 ng/mL (IQR, 478-2763 ng/mL) and adenoma (maximal) diameter of 25.9±14.8 mm were followed for a median of 5.6 years (IQR, 3.0-10.7). Twelve men (21%) suffered from HH persistence at the end of follow-up and 46 men achieved eugonadism. Forty-two out of 46 men (91%) accomplished eugonadism within the rst year following prolactin normalization.In a multivariate logistic regression model, hypopituitarism (OR=10.1; 95% CI 1.10 -101.94), visual eld defect (OR=9.9; 95% CI 1.07 -92.33), and low baseline testosterone levels (OR=0.5; 95% CI 0.29 -0.93) were independent predictors of HH persistence. Conclusion:In our cohort of men with macroprolactinoma that reached prolactin normalization with cabergoline treatment, 21% had HH persistence. Pituitary hormone de ciency, visual eld defects, and low baseline testosterone levels were independently associated with HH persistence. 91% of men achieved eugonadism within the rst year following prolactin normalization. These ndings may support informed clinical decision-making regarding the initiation of testosterone replacement in men with macroprolactinomas.

show abstract

Long‐term response to cabergoline and multi‐modal treatment in men with macroprolactinoma: Does size really matter?

Cited by 9 publications

References 44 publications

Prolactinoma: Clinical Characteristics, Management and Outcome

Prolactinoma: Clinical Characteristics, Management and Outcome

Prolactin-secreting pituitary adenomas: male-specific differences in pathogenesis, clinical presentation and treatment

Predicting hypogonadotropic hypogonadism persistence in male macroprolactinoma

Contact Info

Product

Resources

About