ECE2015 Eposter Presentations Pituitary: clinical (121 abstracts)
Cabergoline is an effective treatment for clinically non-functioning pituitary adenomas
Yona Greenman 1, , Odelia Cooper 6 , Iris Yaish 1 , Eyal Robenshtok 2, , Nadav Sagiv 1 , Tali Jonash-Kimchi 2, , Jayati Mallick 7 , Arkadiusz Gertych 7 , Ilan Shimon 2, , Ram Zvi 2, , Shlomo Melmed 6 & Naftali Stern 1,
1Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; 2Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; 3Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; 4Neuroradiology Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; 5Institute of Endocrinology and Metabolism, Rabin Medical Center, Petach Tikva, Israel; 6Pituitary Center, Cedars Sinai Medical Center, Los Angeles, California, USA; 7Pathology Department, Cedars Sinai Medical Center, Los Angeles, California, USA.
As optimal postoperative management of patients with clinically nonfunctioning pituitary adenomas (NFPA) is a matter of debate, the role of dopamine agonist (DA) therapy in this clinical setting was evaluated.
Methods: Retrospective analysis of prospectively collected data was conducted at two pituitary referral centrer with different standard practices for post-operative management of NFPA: DA therapy or conservative follow up. Dopamine receptor 2 (D2R) expression was examined by immunohistochemistry, D2R long and short isoform mRNA expression was measured by quantitative RT-PCR.
Results: Seventy-nine patients (mean follow-up, 8.8±6.5 years) were treated with DA, either initiated upon detection of residual tumour on postoperative MRI (preventive treatment (PT) group, n=55), or when tumour growth was detected during follow-up (remedial treatment (RT) group, n=24). The control group received no medication and comprised 60 patients (mean follow-up 6.3±5 years). Tumour mass decreased, remained stable or enlarged respectively in 38.2, 49.1, and 12.7% of patients in the PT group. Shrinkage or stabilization was achieved in 58.4% of the enlarging tumours in the RT group, whereas tumour growth persisted in only 41.6% of them. In contrast, tumour size enlarged in 53.3% and remained stable in 46.7% of subjects in the control group (P<0.0001 for all comparisons). 15 years progression-free survival rate was 0.805 for the PT group, 0.48 for the RT group and 0.12 for controls; P<0.0001(PT vs control), P=0.04 (RT vs control), and P=0.0053 (PT vs RT). 41.7% of patients in the control group required additional surgery or radiotherapy as compared to 20.2% of the combined treatment groups (P=0.0084). There was no correlation between D2R expression and tumour response to DA treatment.
Conclusions: Dopamine agonist therapy is associated with decreased prevalence of residual tumour enlargement in patients with non-functioning pituitary adenomas, particularly when treatment is instituted prophylactically after surgical resection.
Disclosure: This work was supported by the Israel Endocrine Society (Young Investigator Award), the Doris Factor Endowment Trust, Novartis (Investigator Initiated Award), and the National Center for Advancing Translational Sciences (grant number UL1TR000124).
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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