Does hypopituitarism recover when macroprolactinomas are treated with cabergoline?

Karavitaki, Niki; Dobrescu, Ruxandra; Byrne, James; Grossman, Ashley; Wass, John

doi:10.1111/cen.12124

Cited by 24 publications

(16 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The data regarding other pituitary hormones is less consistent. We found some recovery of the corticotrophs with no thyrotroph recovery [55], Colao et al [30], found similar patterns, Karavitaki et al [21] showed recovery of thyrotrophs in 25 % of affected patients but no recovery of ACTH secretion and Sibal et al [35] demonstrated re-secretion of both ACTH and TSH in some patients in their cohort.…”

Section: Reviewsupporting

confidence: 67%

“…However, in some patients shrinkage may become noticeable after only 6 months of therapy [31]. Most of the studies (8/11) verified adenoma shrinkage in response to CAB in all [18–21, 23, 24], or almost all [17, 26] patients, totaling 86.6 % of treated patients (see Table 1). …”

Section: Reviewmentioning

confidence: 99%

“…Recovery of the gonadotroph axis was reported in most patients with macroprolactinomas [21, 30, 54, 55]. The data regarding other pituitary hormones is less consistent.…”

Section: Reviewmentioning

confidence: 99%

See 2 more Smart Citations

Management of macroprolactinomas

Tirosh

Shimon

2015

Clin Diabetes Endocrinol

View full text Add to dashboard Cite

Prolactin (PRL) secreting tumors are the most common functional neoplasms of the pituitary and are commonly subdivided into microprolactinomas (<10 mm) and macroprolactinomas (≥10 mm) according to their baseline diameter. Patients with prolactinoma present with symptoms evolving from hyperprolactinemia and with those caused by pressure of the expanding mass on surrounding tissues, including the optic chiasm and the cavernous sinuses. We hereby describe the possible complications of macroprolactinomas, including mass effects, hypopituitarism, CSF leak and apoplexy and discuss their relevant management.In general, all patients harboring macroprolactinomas should be treated, the objectives being to achieve normal or near normal PRL levels, to reduce or stabilize adenoma size and to recover altered pituitary axes. Medical therapy with dopamine agonists (DA) is the preferred initial treatment for the vast majority of patients harboring prolactinomas. Pituitary surgery is indicated in patients who cannot tolerate or are resistant to therapy with DAs, patients that seek fertility and harbor adenomas that impinge on the optic chiasm, psychiatric patients with contraindication to DA treatment and patients presenting with pituitary apoplexy or a cerebrospinal fluid (CSF) leak. In addition, in this review, several patient populations with unique clinical characteristics will be discussed separately namely postmenopausal women, the elderly, children and patients with pituitary carcinoma.

show abstract

Section: Reviewsupporting

confidence: 67%

Section: Reviewmentioning

confidence: 99%

See 1 more Smart Citation

Management of macroprolactinomas

Tirosh

Shimon

2015

Clin Diabetes Endocrinol

View full text Add to dashboard Cite

show abstract

“…In our cohort, few patients had central hypocortisolism and central hypothyroidism at presentation, hence gender difference in this regard could not be commented upon. Reported hypopituitarism (other than hypogonadism) in prolactinomas is based on data derived from small number of patients and with nonidentical diagnostic criteria leading to variable conclusions (10) . We have used 0800 h serum cortisol to define hypocortisolism, due to nonavailability of adrenocorticotrophic hormone (ACTH) pharmaceutical preparation in India.…”

Section: Discussionmentioning

confidence: 99%

Gender differences in macroprolactinomas: a single centre experience

Khare¹,

Lila²,

Patt³

et al. 2016

Endocrine Connections

View full text Add to dashboard Cite

Macroprolactinomas are the most common functional pituitary tumours. Hypotheses proposed to explain predominance of large tumours in males are: i) diagnostic delay, as hyperprolactinaemia remains under recognised in males and ii) gender-specific difference in tumour proliferation indices. Our study objectives are to compare gender differences in clinical, biochemical, radiological features, management outcomes and cabergoline responsiveness in macroprolactinomas. Drug resistance was defined as failure to achieve prolactin normalisation and >50% reduction in tumour volume with cabergoline (3.5 mg/week dose for minimum 6 months duration). The baseline characteristics of 100 patients (56 females and 44 males) with macroprolactinoma were analysed. Drug responsiveness was analysed in 88 treatment naive patients, excluding 12 post-primary trans-sphenoidal surgery cases. We found that females (30.29±10.39 years) presented at younger mean age than males (35.23±9.91 years) (P<0.01). The most common presenting symptom was hypogonadism (oligo-amenorrhoea/infertility) in females (96.15%) and symptoms of mass effect (headache and visual field defects) in males (93.18%). Baseline mean prolactin levels were significantly lower in females (3094.36±6863.01 ng/ml) than males (7927.07±16 748.1 ng/ml) (P<0.001). Maximal tumour dimension in females (2.49±1.48 cm) was smaller than males (3.93±1.53 cm) (P<0.001). In 88 treatment naïve patients, 27.77% females and 35.29% males had resistant tumours (P=0.48). On subgrouping as per maximum tumour dimension (1.1–2 cm, 2.1–4 cm and >4 cm), gender difference in response rate was insignificant. In conclusion, macroprolactinomas are equally prevalent in both sexes. Macroprolactinomas in males predominantly present with symptoms of mass effects, as against females who present with symptoms of hypogonadism. Males harbor larger tumours but are equally cabergoline responsive as those in females.

show abstract

“…The clinical manifestations of prolactinomas relate to mass-effects (most frequently visual field defects, headaches and hypopituitarism) and/or to hyperprolactinemiarelated consequences (hypogonadism and its sequelae and galactorrhea). Primary goals of treatment are reduction in tumor size, achievement of normal prolactin and restoration of gonadal function [7,8]. The treatment of prolactinomas is unique amongst the PitNETs, since they are the only type of pituitary tumor in which first-line approach is medical therapy [with dopamine agonists (DA)] rather than surgery.…”

Section: Introductionmentioning

confidence: 99%

Dopamine agonist resistant prolactinomas: any alternative medical treatment?

Souteiro

Karavitaki

2019

Pituitary

View full text Add to dashboard Cite

Consensus guidelines recommend dopamine agonists (DAs) as the mainstay treatment for prolactinomas. In most patients, DAs achieve tumor shrinkage and normoprolactinemia at well tolerated doses. However, primary or, less often, secondary resistance to DAs may be also encountered representing challenging clinical scenarios. This is particularly true for aggressive prolactinomas in which surgery and radiotherapy may not achieve tumor control. In these cases, alternative medical treatments have been considered but data on their efficacy should be interpreted within the constraints of publication bias and of lack of relevant clinical trials. The limited reports on somatostatin analogues have shown conflicting results, but cases with optimal outcomes have been documented. Data on estrogen modulators and metformin are scarce and their usefulness remains to be evaluated. In many aggressive lactotroph tumors, temozolomide has demonstrated optimal outcomes, whereas for other cytotoxic agents, tyrosine kinase inhibitors and for inhibitors of mammalian target of rapamycin (mTOR), higher quality evidence is needed. Finally, promising preliminary results from in vitro and animal reports need to be further assessed and, if appropriate, translated in human studies.

show abstract

Does hypopituitarism recover when macroprolactinomas are treated with cabergoline?

Cited by 24 publications

References 14 publications

Management of macroprolactinomas

Management of macroprolactinomas

Gender differences in macroprolactinomas: a single centre experience

Dopamine agonist resistant prolactinomas: any alternative medical treatment?

Contact Info

Product

Resources

About