ECE2024 Poster Presentations Pituitary and Neuroendocrinology (120 abstracts)
Long-term pharmacotherapy of giant prolactinomas
Vaclav Hana 1 , Manuela Vaněčková 2 , Michal Krsek 1 , Mikuláš Kosák 1 , Jana Ježková 1 , Václav Hána jr. 1 , Adela Krausova 1 , Pavel Diblík 3 , Pavel Kuthan 3 , Petr Sklenka 3 , David Netuka 4 , Václav Masopust 4 , Martin Májovský 4 & Roman Liščák 5
1First Faculty of Medicine, Charles University, 3rd Department of Internal Medicine, Prague, Czech Republic; 2First Faculty of Medicine, Charles University, Department of Radiodiagnostics, Prague, Czech Republic; 3First Faculty of Medicine, Charles University, Department of Ophtalmology, Prague, Czech Republic; 4First Faculty of Medicine, Charles University, Department of Neurosurgery, Prague, Czech Republic; 5Hospital Na Homolce, Department of Stereotactic and Radiation Neurosurgery, Prague, Czech Republic
Giant prolactinomas (GPs) are prolactin secreting pituitary adenomas (PitNETs) ≥4 cm, usually with prolactinaemia over 1000 mg/l and without co-secretion of other hormones.
Aims: evaluation of long term treatment of GPs, the effect of D2 agonists and of different doses on prolactinaemia, tumour shrinkage and complications.
Patients and methods: 33 patients (27 males, 82%) diagnosed with GP in our department between 1997 - 2020 and subsequently on pharmacotherapy (cabergoline, bromocriptine, terguride) as a first line treatment. Mean age was 41.7 years (range 23 - 71 years). The follow-up ranged 30 months - 23 years. Tumor size was evaluated as the largest diameter (LD) on MRI. Fast tumor shrinkage was considered as LD regression ≥20% in less than 6 months. Fast prolactin normalisation was considered when in <6 months.
Course of pharmacotherapy and Results: 24 patients were on pure D2 agonist pharmacotherapy and 9 had to undergo a surgery during the course of therapy (3 rhinorhea, 3 symptomatic intratumoral bleeding and 3 partial resistance). Three patients underwent stereotactic radiosurgery. The largest tumor was 53x76x65 mm. Suprasellar progression was present in all patients. Dominating clinical signs were visual field defect (26), headache (16), hypogonadism (12). Initial prolactin levels were 250 - 45 500 mg/l. In 3 patients were <1000 mg/l. Tumor shrank in all patients. Fast shrinkage was present in 22/29 (76%) evaluated patients. Slow regression in 7 (24%). Visual field defects improved/normalised in 25/26. Prolactinaemia decreased in all patients and normalised in 31/33. Prolactin normalised on pure pharmacotherapy in <6 months in 14/24, in 6-12 months in 2/24, in >12 months in 6/24 patients and never normalised in 2. Different effects of pharmacotherapy on prolactin normalisation and shrinkage were observed. Eleven patients had both fast normalisation of prolactin and shrinkage; 12 slow normalisation of prolactinaemia, but fast shrinkage; 5 normalised prolactin quickly, but shrinkage was slower. Slow decrease of both was in 1.
Conclusion: Pharmacotherapy of GPs was fully effective as monotherapy in 73%. Complications (rhinorhea, bleeding, resistance) needed neurosurgery (27%) and/or radiosurgery. Fast prolactin normalisation was observed in 71%. Shrinkage of GPs was observed in all and fast in 76%. Discrepance between speed of biochemical and graphical regression is frequently observed and patience is required. High initial D2 agonist doses (cabergoline 3.5mg weekly) led to faster prolactin normalisation, but not to faster shrinkage. Regression of hypogonadism was observed in 39%.
Cooperatio Program ‘Metabolic Diseases 207037’
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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