Radiographic and Hormonal Regression in Prolactinomas: An Analysis of Treatment Failure

Akinduro, Oluwaseun O.; Lu, Victor M.; Izzo, Alessandro; Biase, Gaetano De; Vilanilam, George K.; Gompel, Jamie J. Van; Bernet, Victor; Donaldson, Angela M.; Olomu, Osarenoma; Meyer, Fredric B.; Quiñones‐Hinojosa, Alfredo; Chaichana, Kaisorn L.

doi:10.1016/j.wneu.2019.05.249

Cited by 15 publications

(7 citation statements)

References 36 publications

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“…In our study, all the patients with tumour shrinkage > 30% at the third month reached the goal of >50% volume reduction in the first year and none reached the target later, despite a long follow-up (median 58.6 months). These findings support the concept that the greatest tumour reduction occurs during the first year after CBG treatment and subsequently becomes negligible or not clinically relevant (14,27,28).…”

Section: Discussionsupporting

confidence: 84%

Shrinkage by the third month predicts long-term response of macroprolactinoma after cabergoline

Biagetti

Sarria-Estrada

Ng-Wong

et al. 2021

European Journal of Endocrinology

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Objective: Transsphenoidal surgery (TSS) is mainly indicated in prolactinomas when dopamine agonist treatment fails. However, there is no established early predictor of cabergoline (CBG) response. The present study was aimed to identify predictors of CBG resistance in order to select patients who may benefit from early TSS. Design: retrospective longitudinal study Methods: We reviewed the medical record of patients diagnosed with prolactinoma after 2010. Inclusion criteria: macroprolactinomas under CBG treatment with serial prolactin levels and MRI before treatment and 3 and 12 months afterwards. The main outcome was tumour size shrinkage ≥50% after 12 months of CBG (TS_50). The capacity of the most important clinical and biochemical variables in predicting the main outcome was examined. Results: A total of 185 prolactinomas where included: 124 (67.0 %) were microadenomas and 61 (33.0%) were macroadenomas of which 27 patients meet de inclusion criteria; median age [42.5 years; (IQR: 28.0)]. The median of follow up was [67.5 months; (IQR: 30.2)]. Ten patients (37.0%) underwent surgery after more than one year of CBG. The volume reduction at the first MRI (3-4 months) was the unique valuable predictor: [OR: 1.16 (IC 95% 1.02-1.32)] of TS_50. A tumour volume shrinkage ≥30% in the first 3-4 months of CBG therapy predicts TS_50 with an AUC [ 0.95 (CI: 0.76-0.99)]. Conclusion: Tumor shrinkage in the first 3-4 month after starting treatment with CBG is a good tool for predicting the long term response and can help clinicians to take more appropriated and personalized decisions.

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Section: Discussionsupporting

confidence: 84%

Shrinkage by the third month predicts long-term response of macroprolactinoma after cabergoline

Biagetti

Sarria-Estrada

Ng-Wong

et al. 2021

European Journal of Endocrinology

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“…The study found evidence of plateaus in both the size regression of prolactinoma tumors, as well as the PRL level reduction. Both were found to have the greatest and most rapid reduction during the first 6 months of DA therapy, which then tapered off during the following 6 months, and diminished further thereafter [23].…”

Section: Prolactinomasmentioning

confidence: 90%

Updates in the Medical Treatment of Pituitary Adenomas

2019

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Pituitary adenomas represent approximately 15% of brain tumors; incidence is significantly on the increase due to widespread use of magnetic resonance imaging. Surgery remains the first-line treatment for most tumors overall. The role of dopaminergic agonists (DAs) and somatostatin receptor ligands (SRLs) in the treatment of pituitary adenomas is quite well established for prolactinomas and growth hormone (GH) excess. However, over the last decade new multi-receptor binding SRLs are increasingly used for treatment of acromegaly and Cushing’s disease. SRLs/DA chimeric compounds seem to have enhanced potency and efficacy when compared to that of individual SRLs or DA receptor agonists according to preclinical data. However, following negative results, more research is needed to determine if this interesting mechanism will translate into positive clinical effects for acromegaly patients. Furthermore, new agents that block adrenal steroidogenesis have been developed in phase III clinical trials for Cushing’s disease and several new compounds working at the pituitary level and/or blocking the glucocorticoid receptor are also in development. Combination therapy of drugs with similar or different mechanisms (possibly synergistic) are also on the increase. A growing awareness regarding all mechanisms involved in both control of pituitary secretion and cellular proliferation might allow for sole medical treatment of pituitary adenomas, especially macroadenomas, rather than surgery and/or radiation therapy, in the future. Moreover, the underlying decision on how to treat patients with pituitary adenomas should be individualized on a case-by-case basis with not only a goal of tumor shrinkage and biochemical control, but also of improving patients’ quality of life.

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“… 2 The procedures in our study that showed an increase or no change were the microsurgeries for intracranial tumor with complementary technique (4.79%) and microsurgery of spinal tumors with complementary technique (0%), indicating that prompt action in these procedures is necessary to clinical and functional deterioration, neurologic complications, compressive effects, or even death. 15 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 …”

Section: Discussionmentioning

confidence: 99%

Impact of COVID-19 on Neurosurgery in Brazil's Health System: The Reality of a Developing Country Affected by the Pandemic

et al. 2021

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Radiographic and Hormonal Regression in Prolactinomas: An Analysis of Treatment Failure

Cited by 15 publications

References 36 publications

Shrinkage by the third month predicts long-term response of macroprolactinoma after cabergoline

Shrinkage by the third month predicts long-term response of macroprolactinoma after cabergoline

Updates in the Medical Treatment of Pituitary Adenomas

Impact of COVID-19 on Neurosurgery in Brazil's Health System: The Reality of a Developing Country Affected by the Pandemic

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