MRI follow-up is unnecessary in patients with macroprolactinomas and long-term normal prolactin levels on dopamine agonist treatment

Eroukhmanoff, Juliette; Tejedor, Isabelle; Potorac, Iulia; Cuny, Thomas; Bonneville, J. F.; Dufour, Henry; Weryha, G.; Beckers, Albert; Touraine, Philippe; Brue, Thierry; Castinetti, Frédéric

doi:10.1530/eje-16-0897

Cited by 27 publications

(8 citation statements)

References 25 publications

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“…Sellar MRI was performed at diagnosis and a year after treatment initiation (±3 months) in all patients. Patients who did not normalise prolactin had annual imaging beyond 12 months of treatment, until prolactin normalisation and/or when significant tumour shrinkage was evident 14,30 . Additional imaging was performed according to the treating physician's decision.…”

Section: Study Design and Methodsmentioning

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: Study Design and Methodsmentioning

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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“…There was no routine follow-up to control the tumor size by means of sellar MRI. [48,49] Patients were considered to be in remission if the PRL level was < 20 µg/L at follow-up.…”

Section: Postoperative and Long-term Assessmentmentioning

confidence: 99%

First-line surgery in prolactinomas: lessons from a long-term follow-up study in a tertiary referral center

Andereggen

Frey

Andres

et al. 2021

J Endocrinol Invest

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Context Although consensus guidelines recommend dopamine agonists (DAs) as the first-line approach in prolactinomas, some patients may opt instead for upfront surgery, with the goal of minimizing the need for continuation of DAs over the long term. While this approach can be recommended in selected patients with a microprolactinoma, the indication for upfront surgery in macroprolactinomas remains controversial, with limited long-term data in large cohorts. We aimed at elucidating whether first-line surgery is equally safe and effective for patients with micro- or macroprolactinomas not extending beyond the median carotid line (i.e., Knosp grade ≤ 1). Methodology Retrospective study of patients with prolactinomas Knosp grade ≤ 1 treated with upfront surgery. The primary endpoint was patients’ dependence on DAs at last follow-up. The secondary endpoint was postoperative complications. Independent risk factors for long-term dependence on DAs were analyzed. Results A microadenoma was noted in 45 patients (52%) and a macroadenoma in 41 (48%), with 17 (20%) harboring a Knosp grade 1 prolactinoma. Median follow-up was 80 months. First-line surgery resulted in long-term remission in 31 patients (72%) with a microprolactinoma and in 18 patients (45%) with a macroprolactinoma (p = 0.02). DA therapy was ultimately required in 11 patients (24%) with microadenomas vs. 20 (49%) with macroadenomas (p = 0.03). As for the latter, DA was required in 13 patients (76%) with Knosp grade 1 macroadenomas vs. 7 patients (29%) with Knosp grade 0 macroadenomas (p = 0.004). There was no mortality, and morbidity was minimal. Knosp grade 1 prolactinomas (OR 7.3, 95% CI 1.4–37.7, p = 0.02) but not adenoma size (i.e., macroprolactinomas) were an independent predictor of long-term dependence on DAs. Conclusions First-line surgery in patients with microprolactinomas or macroprolactinomas Knosp grade 0 resulted in a good chance of non-dependency on DA therapy. However, in patients with prolactinomas Knosp grade 1, first-line surgery cannot be recommended, as adjuvant DA therapy after surgery is required in the majority of them over the long term.

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“…It should be noted that the only increase in adenoma height (3 mm) after an initial decrease was secondary to a clinically asymptomatic hemorrhagic transformation of microadenoma. In a study of MRI monitoring of macroprolactinomas controlled by medical treatment with dopamine agonists, tumor shrinkage was observed in most patients and 18% had an increase in adenoma volume secondary to asymptomatic hemorrhagic transformations (21). Therefore, in patients with acromegaly sensitive to SMSa, the effects on tumor volume reduction are less significant than those observed during treatment with dopaminergic agonists in prolactinoma.…”

Section: Discussionmentioning

confidence: 98%

Is MRI follow-up relevant in patients with GH-secreting pituitary adenomas primarily treated and responsive to long-acting somatostatin analogues (SMSa)?

Grandgeorge

Barchetti

Grunenwald

et al. 2020

European Journal of Endocrinology

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Objective Primary SMSa treatment can be associated with hormonal control and tumor shrinkage in patients with GH-secreting pituitary adenomas. The aim of this study was to evaluate whether regular MRI follow-up was necessary in patients with acromegaly-treated and responsive to first-generation long-acting SMSa. Patients and methods In this retrospective monocentric study we included patients with GH/IGF-1 hypersecretion and pituitary adenomas with normal visual field, primarily treated with first-generation long-acting SMSa between 1995 and 2015 and regularly monitored (clinical evaluation, GH/IGF-1 levels and pituitary MRI) for at least 3 years. Results We included 83 patients (32 men and 51 women, mean age at diagnosis 50 ± 12 years) with mean GH = 19.3 ± 25.6 ng/mL, IGF-1 = 284 ± 110% ULN and pituitary adenoma height = 12.9 ± 4.7 mm. Mean follow-up was 8.9 ± 4.9 years in 36 controlled patients and 2.0 ± 1.6 years in 47 partial responders to SMSa alone. No significant increase in pituitary adenoma height was observed. Pituitary adenoma height decreased significantly in controlled patients (diagnosis: 11.9 ± 4.8 mm, SMSa: 9.6 ± 3.3 mm, P < 0.001), and in partially responders (diagnosis: 13.6 ± 4.5 mm, SMSa: 11.5 ± 4.5 mm, P < 0.001). Conclusion During SMSa treatment, no significant increase in GH-secreting adenoma size was observed. Primary SMSa treatment was associated with a significantly decrease in adenoma height in our population. Our cohort data suggest that regular MRI follow-up does not seem relevant in patients with acromegaly who are responsive to SMSa treatment.

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MRI follow-up is unnecessary in patients with macroprolactinomas and long-term normal prolactin levels on dopamine agonist treatment

Abstract: No significant increase of tumor size was observed in our patients with controlled prolactin levels on DA. MRI follow-up thus appears unnecessary in patients with biologically controlled macroprolactinomas.

Cited by 27 publications

References 25 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?

First-line surgery in prolactinomas: lessons from a long-term follow-up study in a tertiary referral center

Is MRI follow-up relevant in patients with GH-secreting pituitary adenomas primarily treated and responsive to long-acting somatostatin analogues (SMSa)?

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