Giant prolactinomas: clinical management and long-term follow up

Abstract

According to long-term follow-up findings, giant prolactinomas are exquisitely responsive to dopamine agonist therapy. In giant prolactinomas the prolactin level does not correlate with size. The main indication for early surgery is intratumoral hematoma, whereas our main indications for late surgery are cerebrospinal fluid leakage caused by medical treatment, or an increasing prolactin level despite medical therapy. Checking prolactin levels in suspicious sellar and/or suprasellar lesions may be diagnostic and prevent unnecessary surgery.

Effectiveness of long-term cabergoline treatment for giant prolactinoma: study of 12 men

“…However, complete surgical removal of giant tumors that extend into the suprasellar, parasellar, and infrasellar areas is difficult, and biochemical cure is rare even after extensive tumor removal (15)(16)(17). After surgery, most patients still require medical therapy (1,15,16), as occurred in two of our patients as well. Moreover, surgery for giant pituitary adenomas is associated with high mortality and morbidity rates, especially when done through craniotomy (18,19).…”

“…Giant prolactinomas are rare invasive large pituitary tumors, usually identified in men (1,2). Surgical debulking may be employed to induce rapid optic decompression and visual improvement, or to prevent pituitary apoplexy in patients refractory to dopamine agonists (14).…”

“…Giant prolactinomas are a rare subset of macroadenomas, characterized by large size (more than 40 mm in diameter), high aggressiveness, and massive extrasellar involvement (1,2). They are usually associated with very high serum PRL levels (O1000 ng/ml).…”

Cerebrospinal fluid rhinorrhoea in young women after 6.5 years of therapy giant prolactinoma with Cabergolin

“…Гигантские пролактиномы -редко встре-чающиеся опухоли, описаны в основном у мужчин, обладают агрессивным характером роста, разрушают структуры основания че-репа, распространяясь в кавернозный синус, основную пазуху, носоглотку [1,2].…”

“…При нейроофтальмологическом ос-мотре диагностированы зрительные нарушения в виде битемпоральной гемианопсии и снижения остроты зрения (VIS OD = 0,6), правостороннего экзофтальма (3 мм). В гормональном анализе крови уровень пролактина (ПРЛ) -2 218 283 (40-530) мЕд/л, макропролактин -34%, ТТГ -1,29 (0,4-4) мЕд/л, св.Т 4 -13,0 (10-22) нмоль/л, кор-тизол -701 (138-690) нмоль/л, ЛГ -0,993 (1,(9)(10)(11)(12)5) мЕд/л, ФСГ -7,18 (2,(5)(6)(7)(8)(9)(10)2) мЕд/л, эстра-диол -76 (72-529) пмоль/л, тестостерон -0,894 (0,5-2,6) нмоль/л. Выявлено значимое повыше-ние уровня ПРЛ, данных за гипотиреоз и гипокор-тицизм не получено.…”