Giant prolactinomas: the therapeutic approach

Area of Science:

• Endocrinology
• Neurosurgery
• Oncology

Background:

• Giant prolactinomas are rare macroprolactinomas, more prevalent in men.
• Defining giant prolactinomas and understanding their treatment is crucial.

Purpose of the Study:

• To propose a definition for giant prolactinomas.
• To review therapeutic options for biochemical and tumor volume control.

Main Methods:

• A systematic literature search was conducted in PubMed and Ovid from April to November 2012.

Main Results:

• Giant prolactinomas are defined as adenomas >4cm with prolactin levels >5300 mIU/l.
• Cabergoline is the preferred first-line medical treatment, achieving normalization and tumor reduction in most patients.
• Combined therapy (e.g., cabergoline and surgery) or other options like radiotherapy and temozolomide may be necessary for aggressive cases.

Conclusions:

• There is a lack of large studies on giant prolactinoma management.
• Cabergoline is the primary treatment, but treatment comparisons require caution due to study variability.
• A standardized definition and larger patient series are needed to accurately assess treatment efficacy and safety.