Prolactinoma - which patients react favorably to cabergoline medication?

Abstract

Objective. Prolactinoma, as a common endocrine disorder and the most frequent type of pituitary tumor, acts primarily as a suppressor on the gonadal functions. It is generally successfully treated with dopamine agonists; however, treatment resistance still remains in an unneglectable ratio. In this study, we aimed to identify factors, which may play a role in the treatment response. Methods. Seventy-six patients with prolactinoma, who have been routinely followed between 2018 and 2022 in Istanbul Research and Educational Hospital Endocrinology Outpatient Clinic, were included into the study. Initial prolactin level, adenoma size, baseline weight, body mass index (BMI), glucose, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and triglyceride levels were obtained from the patient’s medical records. The patients were divided into two groups: treatment respondent and non-respondent (refractory) ones, according to treatment response in the duration as suggested by the guidelines. The treatment respondent and non-respondent groups were compared according to the initial and the 3rd month prolactin levels, adenoma size, weight, BMI, and metabolic values. Results. The initial tumor diameter was 15.27±10.62 mm in the refractory and 7.42±4.42 mm in the treatment respondent groups (p=0.01). The refractory group had higher prolactin baseline level 269.96±275.78 µg/l vs. 124.55±67.35 µg/l of the respondent group (p=0.01). The refractory group had higher the 3rd month prolactin level 50.97±52.55 µg/l vs. 29.70±27.31 µg/l of the respondent group (p=0.04). The refractory group had higher frequency of cystic/hemorrhagic adenoma (47.6%, n=11/21) (p=0.01), baseline pituitary failure (33.3%, n=7/21) (p=0.01), and baseline cavernous sinus invasion (25.8, n=5/21) (p=0.01). The treatment respondent group had lower initial body weight (69.54±17.51 kg vs. 83.29±16.21 kg) (p<0.01), and lower BMI (25.98±5.47 kg/m2 vs. 27.69±6.42 kg/m2) (p=0.02). Conclusions. In this study, initial tumor size, male gender, weight, BMI, the 3rd month prolactin level, initial pituitary deficiency, and cystic/hemorrhagic component in pituitary imaging in patients with prolactinoma were associated with a lower treatment response.

Pathology of sellar tumors: A contemporary diagnostic approach

“…Lactotroph tumors are the most frequent tumors of the anterior pituitary and they cause hyperprolactinemia. Intriguingly, they are extremely rare in surgical series owing to a very successful treatment with dopamine agonists (12). Currently, surgical treatment of prolactinomas is performed in rare cases resistant to dopamine agonists therapy (13).…”

Patient-reported outcomes in refractory hormone-producing pituitary adenomas: an unmet need

“…Moreover, 'refractory tumors' or refractoriness was not defined in the 4th edition of the World Health Organization Guidelines for Classification of Pituitary Tumors [1]. Throughout the current literature, multiple definitions have therefore been used depending on the type of pituitary adenoma: adenomas not responding to conventional doses of dopamine agonists (DAs) in prolactinomas [2][3][4], failure of pituitary tumor resection or radiotherapy (RT) in Cushing's Disease (CD) [5], and a combination of (a) Ki-67 index > 3%, (b) > 2% monthly growth, (c) resistance to current treatments and (d) recurrence ≤ 6 months after surgery for all pituitary adenomas [6].…”