ECE2023 Poster Presentations Pituitary and Neuroendocrinology (123 abstracts)
Prolactinomas under high doses cabergoline in portuguese patients: The Resistant Prolactinoma Study
Inês Manique 1 , Vânia Benido Silva 2 , Davide Carvalho 3 , Olinda Marques 4 , Ema Nobre 5 , Maria João Bugalho 5 , Ana Palha 1 , Isabel Ribeiro 6 , Josué Pereira 7 , Rui Almeida 8 , Amets Sagarribay 9 , Luís Cerqueira 10 & Cláudia Amaral 11
1Centro Hospitalar Universitário de Lisboa Central, Endocrinology, Lisboa, Portugal; 2Centro Hospitalar Universitário do Porto, Endocrinology, Portugal; 3Centro Hospitalar Universitário de São João, Endocrinology, Portugal; 4Hospital de Braga, Endocrinology, Braga, Portugal; 5Centro Hospitalar Universitário Lisboa Norte, Endocrinology, Lisboa, Portugal; 6Centro Hospitalar Universitário do Porto, Neurosurgery, Porto, Portugal; 7Centro Hospitalar Universitário de São João, Neurosurgery, Porto, Portugal; 8Hospital de Braga, Neurosurgery, Braga, Portugal; 9Centro Hospitalar Universitário de Lisboa Central, Neurosurgery, Lisboa, Portugal; 10Centro Hospitalar Universitário de Lisboa Central, Neuroradiology, Lisboa, Portugal; 11Centro Hospitalar Universitário do Porto, Endocrinology, Porto, Portugal
Background: In 15% of prolactinomas there is dopamine agonist(DA) resistance. The clinical characteristics, the best diagnostic and therapeutic management of these cases have not been established so far.
Aim: To characterize patients taking a high dose cabergoline(≥ 3mg/week) and then describe clinical, biochemical and imaging features of cabergoline-resistant cases.
Methods: Retrospective study with 5 centers representing the contribution of Pituitary Study Group of SPEDM to ”RESISTANT PROLACTINOMA STUDY”(ENEA Workshop and Study Committee). Clinical, biochemical and imaging data, diagnostic approaches, treatment options and outcomes were assessed. Cabergoline-resistant prolactinoma was defined as tumors treated with ≥3mg/week cabergoline for at least 6 months without achieving prolactin level normalization.
Results: Twenty patients, 55%(n=11) males with a median age at diagnosis of 29 years(Interquartile range[IQR]:13) were included. Median initial prolactin level was 2117ng/ml(IQR:4005) and largest tumor dimension 28mm(IQR:25.3). All prolactinomas were macroadenomas. Parasselar, suprasselar and infrasellar intraesphenoidal growth was verified in 80%(n=16), 80%(n=16) and 60%(n=12) respectively, and optic chiasm compression in 20%(n=4). At diagnosis, 40%(n=8) presented visual disturbances and 15%(n=3) pituitary apoplexia. Hypogonadotropic hypogonadism was established in 85%(n=17), central hypothyroidism in 30%(n=6) and secondary adrenal insufficiency in 20%(n=4). Cabergoline was the first treatment in 80%(n=16). Eighteen prolactinomas(90%) were defined as cabergoline-resistant, and 75%(n=15) did not decrease their size by ≥50%. Fifteen patients(75%) did an alternative treatment, achieving prolactin normalization in only 6,7%(n=1) and decrease in ≥50% of tumor size in 33%(n=5). Cabergoline median dose needed to decrease ≥50% of tumor was 4mg(IQR:0.5), the maximum median dose prescribed >3months without prolactin normalization was 3.25mg(IQR:1) and without tumor reduction was 3mg(IQR:0.5). One patient had metastasis and 30%(n=6) had tumor relapse.
Conclusions: The male sex, tumor invasiveness and the magnitude of hyperprolactinemia are known predictors DA-resistance, and our results are consistent with that. The efficacy of alternative treatments in this type of lesions was scarce, either in prolactin normalization or tumor shrinkage. This study will contribute, we hope, to improve the understanding of the natural history of cabergoline-resistant prolactinomas.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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