Giant invasive prolactinomas

Murphy, Fred Y.; Vesely, David L.; Jordan, Richard M.; Flanigan, Stevenson; Kohler, Peter O.

doi:10.1016/0002-9343(87)90668-1

Cited by 44 publications

(43 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A tumour size criterion is universally recognized (6,7,8,11,12,13,14,15) and is important as giant prolactinomas will cause specific complications related to invasion of the dura, the subarachnoid space, the clivus, the nasopharyngeal space, internal auditory canals and surrounding brain structures. Thus, such tumours are more aggressive and usually not completely resectable.…”

Section: Definition and Epidemiologymentioning

confidence: 99%

“…As serum hormone levels generally parallel tumour size, giant prolactinomas are typically associated with very high PRL concentrations, above 1000 mg/l (21 000 mU/l) (4,15,21). While most non-surgical series published in the literature indeed used this criterion of 1000 mg/l (7,12,15,20,22,23,24), higher cut-off levels of 2000 mg/l (25), 3000 mg/l (8) or even 4000 mg/l (11) have also been used. At the opposite, lower and more conservative PRL thresholds of 200 or 250 mg/l, similar to those used for non-giant macroprolactinomas, have also been proposed previously (6,26), although assay problems were mentioned in the latter report and accurate PRL concentrations were not available in some cases.…”

Section: Definition and Epidemiologymentioning

confidence: 99%

“…1A and B). These include impaired hearing (12,13,34,35), unilateral hemiparesis (35), temporal epilepsy (36) -usually manifesting by complex partial seizures with oral automatism, olfactory hallucinations, This study included two patients with PRL concentration below 1000 mg/l (201 and 400 mg/l).…”

Section: Presenting Featuresmentioning

confidence: 99%

“…Orbital invasion is another rare extrasellar extension of pituitary tumours and will cause exophthalmos and optic nerve compression at the orbital apex (31,46,56). Finally, in the opposite direction, posterior and inferior extension may cause ataxia by cerebellar compression (57,58) or cranio-cervical junction instability (12,13,59). …”

Section: Presenting Featuresmentioning

confidence: 99%

“…Giant prolactinomas are usually associated with very high serum PRL concentrations, in the range of 1000-100 000 mg/l when measured with a two-site monoclonal IRMA or chemiluminometric assay (ILMA) ( (4,5,6,7,11,12,13,14,15), Table 1). When such very high PRL concentrations are observed, diagnosis is obvious (60,61).…”

Section: Hormonal Evaluationmentioning

confidence: 99%

See 4 more Smart Citations

THERAPY OF ENDOCRINE DISEASE: The challenges in managing giant prolactinomas

Maiter

Delgrange

2014

European Journal of Endocrinology

158

166

View full text Add to dashboard Cite

Giant prolactinomas are rare tumours, representing only 2-3% of all prolactin (PRL)-secreting tumours and raising special diagnostic and therapeutic challenges. Based on several considerations developed in this review, their definition should be restricted to pituitary adenomas with a diameter of 40 mm or more, significant extrasellar extension, very high PRL concentrations (usually above 1000 mg/l) and no concomitant GH or ACTH secretion. Giant prolactinomas are much more frequent in young to middle-aged men than in women, with a male to female ratio of about 9:1. Endocrine symptoms are often present but overlooked for a long period of time, and diagnosis is eventually made when neurologic complications arise from massive extension into the surrounding structures, leading to cranial nerve palsies, hydrocephalus, temporal epilepsy or exophthalmos. PRL concentrations are usually in the range of 1000-100 000 mg/l, but may be underestimated by the so-called 'high-dose hook effect'. As in every prolactinoma, dopamine agonists are the first-line treatment allowing rapid alleviation of neurologic symptoms in the majority of the cases, a significant reduction in tumour size in three-fourths of the patients and PRL normalization in 60-70%. These extensive tumours are usually not completely resectable and neurosurgery has significant morbidity and mortality. It should therefore be restricted to acute complications such as apoplexy or leakage of cerebrospinal fluid (often induced by medical treatment) or to patients with insufficient tumoural response or progression. Irradiation and temozolomide are useful adjuvant therapies in a subset of patients with aggressive/invasive tumours, which are not controlled despite combined medical and surgical treatments. Because of these various challenges, we advocate a multidisciplinary management of these giant tumours in expert centres.

show abstract

Section: Definition and Epidemiologymentioning

confidence: 99%

Section: Definition and Epidemiologymentioning

confidence: 99%

Section: Presenting Featuresmentioning

confidence: 99%

Section: Presenting Featuresmentioning

confidence: 99%

Section: Hormonal Evaluationmentioning

confidence: 99%

See 3 more Smart Citations

THERAPY OF ENDOCRINE DISEASE: The challenges in managing giant prolactinomas

Maiter

Delgrange

2014

European Journal of Endocrinology

158

166

View full text Add to dashboard Cite

show abstract

A giant prolactinoma presenting with unilateral exophthalmos: Effect of cabergoline and review of the literature

Berwaerts

Verhelst

Abs

et al. 2000

J Endocrinol Invest

View full text Add to dashboard Cite

We report the case of a 45-year-old male presenting with unilateral exophthalmos due to a large tumoral mass invading the skull base. Ophthalmologic examination did not show any visual field defects. Imaging techniques demonstrated extension of a huge tumor (approx. 8x8x8 cm) into the right orbit and nasopharynx. Endocrine work-up revealed grossly elevated serum prolactin (PRL) levels (26,466 microg/l, nl. < 12), pointing to a large, invasive macroprolactinoma. Stimulation tests indicated associated partial adrenal and growth hormone deficiencies. Planned surgery was abandoned, and the patient was instead treated with the long-acting dopamine agonist, cabergoline. Over a period of one year, serum PRL dropped to 131 microg/l, while the tumor mass shrank to less than 50% of its original volume (with 3.5 mg/week of cabergoline). The exophthalmos disappeared, and the patient did not develop rhinorrhea or any other side effects from treatment with cabergoline. The efficacy was maintained throughout the second year (ultimate serum PRL 74 microg/l, and final size less than 10% of the original). With reference to this case, we review other macroprolactinomas reported in the recent literature for associated exophthalmos, grossly elevated serum PRL levels (> or = 15,000 microg/l), and/or "giant" size (> or = 4 cm in maximum diameter). We highlight the use of dopamine agonists in the treatment of prolactinomas with such unusual characteristics.

show abstract

Long-term Efficacy of Bromocriptine in Macroprolactinomas and Giant prolactinomas in Men

Chattopadhyay

Bhansali²,

Masoodi³

2005

Pituitary

View full text Add to dashboard Cite

We prospectively analyzed presentations and long-term therapeutic responses to bromocriptine (BRC) in 29 newly diagnosed men with macroprolactinomas including 14 patients with 'giant prolactinoma'. Clinical symptoms, prolactin (PRL) levels and tumor size on MRI were measured before BRC and sequentially thereafter. The duration of follow-up were 6 to 96 (30.7 +/- 14.4) months. Pretreatment PRL ranged between 124 and 29200 ng/mL (1698 +/- 857.1) and tumor volume was between 2.81 and 132 cm(3) (21.1 +/- 24.3). Baseline PRL levels did not correlated with tumor volume (r = 0.45, P > 0.05). Significant decrease (P = 0.0003) in PRL, at least 96% of the pretreatment value from 1698 +/- 857.1 ng/mL to 42.4 +/- 30.6 ng/mL occurred in 26 patients. Persistent normalization of PRL levels (< 16 ng/mL) for at least 6 months was achieved in 12 patients (40.8%). Twenty-two patients (74.8%) achieved significant tumor shrinkage (P = 0.005) at study completion. An improvement in visual field defects (VFD) and restoration of libido and potency was observed in 40% and 33.3%, respectively. Trans-sphenoidal / trans-frontal pituitary surgery was performed in 9 patients (31%) for various reasons: pituitary apoplexy in 1, CSF rhinorrhea in 2, increasing prolactin in spite of BRC therapy in 3, and intolerant /resistant to BRC in 3 patients. These data suggest that, in male macro- and giant prolactinomas, dopamine agonists represent the first-line therapy effective in reducing PRL, restoration of libido and potency, improvement of VFD and determining tumor shrinkage.

show abstract

Giant invasive prolactinomas

Cited by 44 publications

References 32 publications

THERAPY OF ENDOCRINE DISEASE: The challenges in managing giant prolactinomas

THERAPY OF ENDOCRINE DISEASE: The challenges in managing giant prolactinomas

A giant prolactinoma presenting with unilateral exophthalmos: Effect of cabergoline and review of the literature

Long-term Efficacy of Bromocriptine in Macroprolactinomas and Giant prolactinomas in Men

Contact Info

Product

Resources

About