Macroprolactinomas: longitudinal assessment of biochemical and imaging therapeutic responses

Araújo, Catarina; Marques, Olinda; Almeida, Rui; Santos, Maria Joana

doi:10.1007/s12020-018-1703-4

Cited by 12 publications

(7 citation statements)

References 19 publications

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“…The goal of therapy is symptomatic relief by means of prolactin suppression, testosterone normalisation, tumour size reduction and visual field recovery 14,15 . Different studies have shown that prolactin suppression to normal values was achieved in 80%–90% of macroprolactinomas 20,21 compared with a lower rate of 60%–70% in giant prolactinomas 22,23 …”

Section: Introductionmentioning

confidence: 99%

Long‐term response to cabergoline and multi‐modal treatment in men with macroprolactinoma: Does size really matter?

Rudman

Duskin-Bitan

Manisterski

et al. 2021

Clinical Endocrinology

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Objective To study the outcome of men with macroprolactinoma following cabergoline treatment based on tumour size. Design Retrospective cohort study. Methods The study included 94 men, divided into three groups according to adenoma diameter: 10–19 mm (Group A, n = 36); 20–39 mm (Group B, n = 41); or ≥40 mm (Group C, giant prolactinomas, n = 17). Patients were followed for a mean of 7.5 years with sellar magnetic resonance imaging, visual fields and hormone measurements. Results Mean baseline prolactin was 767, 2090 and 24,806 ng/ml in Groups A, B and C, respectively (p < .01). Prolactin suppression below three times the upper limit of normal (ULN) was achieved in 34 (94%; mean weekly cabergoline dose of 1.2 mg), 37 (90%; cabergoline dose, 2.1 mg) and 15 (88%; cabergoline dose, 2.8 mg) men (p = .31) in each group. After excluding patients who underwent surgery and radiotherapy, cabergoline suppressed prolactin below three times ULN in 32/35 (91%), 29/37 (78%) and 11/14 (79%) men in Groups A, B and C, respectively (p = .27). Visual deficits were observed in 5 (14%), 12 (29%) and 10 (59%) patients (p < .01); improvement was achieved in 5/5 (100%), 11/12 (92%) and 10/10 (100%) of men in Groups A, B and C. Low baseline testosterone was measured in 26 (72%), 39 (95%) and 17 (100%) patients in the three groups (p < .01). Following multi‐modal treatment, hypogonadism persisted in 3 (8%), 5 (12%) and 2 (12%) men, respectively (p = .85). Conclusion Macroprolactinomas in men were controlled with cabergoline in 84% of cases, independent of tumour size. Pituitary surgery and adjuvant radiotherapy further improved long‐term response to 91%.

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Section: Introductionmentioning

confidence: 99%

Long‐term response to cabergoline and multi‐modal treatment in men with macroprolactinoma: Does size really matter?

Rudman

Duskin-Bitan

Manisterski

et al. 2021

Clinical Endocrinology

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“…Resistance is more frequent in cases of MP, invasive tumors, and male patients. Other factors are very young age, cystic, hemorrhagic and/or necrotic components (before the start of pharmacological treatment) inside the tumor, and genetic predisposition to develop pituitary tumors such MEN-1 or AIP mutations ( 228 , 230 , 231 ).…”

Section: Therapeutic Issuesmentioning

confidence: 99%

Italian Association of Clinical Endocrinologists (AME) and International Chapter of Clinical Endocrinology (ICCE). Position statement for clinical practice: prolactin-secreting tumors

Cozzi

Ambrosio

Attanasio³

et al. 2022

European Journal of Endocrinology

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Prolactinomas are the most frequent pituitary adenomas. Prolactinoma may occur in different clinical settings and always require an individually tailored approach. This is the reason why a panel of Italian neuroendocrine experts was charged with the task to provide indications for the diagnostic and therapeutic approaches that can be easily applied in different contexts. The document provides 15 recommendations for diagnosis and 54 recommendations for treatment, issued according to the GRADE system. The level of agreement among panel members was formally evaluated by RAND-UCLA methodology. In the last century prolactinomas represented the paradigm of pituitary tumors for whom the development of highly effective drugs obtained the best results, allowing to avoid neurosurgery in most cases. The impressive improvement of neurosurgical endoscopic techniques allows a far better definition of the tumoral tissue during surgery and the remission of endocrine symptoms in many patients with pituitary tumors. Consequently, this refinement of neurosurgery is changing the therapeutic strategy in prolactinomas, allowing the definitive cure of some patients with permanent discontinuation of medical therapy.

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“…Araujo et al . [ 79 ] reported an asynchronous relationship between PRL levels and tumor size after cabergoline treatment. The study found that 87% of patients had normalisation of PRL levels in the first 2 years of therapy, whereas only 62% had >50% reduced tumor size.…”

Section: E Ffectiveness Of C Abergolinementioning

confidence: 99%

“…The study found that 87% of patients had normalisation of PRL levels in the first 2 years of therapy, whereas only 62% had >50% reduced tumor size. [ 79 ] Fibrosis in the prolactinoma has been described after long-term therapy with bromocriptine and rarely with cabergoline therapy. [ 27 80 ] Mohan et al .…”

Section: E Ffectiveness Of C Abergolinementioning

confidence: 99%

A scoping review to understand the indications, effectiveness, and limitations of cabergoline in radiological and biochemical remission of prolactinomas

Mishra¹,

Konar²,

Shrivastava³

et al. 2021

Indian J Endocr Metab

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Cabergoline has long been used in the medical management of prolactin-secreting pituitary adenomas. However, there is contradicting and inadequate evidence on the efficacy of cabergoline in achieving radiological and biochemical remission in prolactinoma. This article presents scoping review of evidence in cabergoline achieving radiological and biochemical remission in cases of prolactinoma. We have used a recommended scoping review methodology to map and summarize existing research evidence and identify knowledge gaps. The review process was conducted according to the PRISMA-ScR guidelines (Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews). The selection of studies was based on the criteria defined. Essential information such as reference details, study characteristics, topics of interest, main findings, and the study author's conclusion are presented in text and tables. With the study selection process, eight publications were finally included—one systematic review and meta-analysis, one RCT, and six primary studies. Cabergoline is effective in achieving biochemical and radiological remission in cases of prolactinoma. We identified several knowledge gaps with the scoping review and directions for future studies. Future studies, including randomized studies, will help address challenging questions associated with the management of prolactinoma.

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Macroprolactinomas: longitudinal assessment of biochemical and imaging therapeutic responses

Cited by 12 publications

References 19 publications

Long‐term response to cabergoline and multi‐modal treatment in men with macroprolactinoma: Does size really matter?

Long‐term response to cabergoline and multi‐modal treatment in men with macroprolactinoma: Does size really matter?

Italian Association of Clinical Endocrinologists (AME) and International Chapter of Clinical Endocrinology (ICCE). Position statement for clinical practice: prolactin-secreting tumors

A scoping review to understand the indications, effectiveness, and limitations of cabergoline in radiological and biochemical remission of prolactinomas

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