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Giant prolactinomas: are they really different from ordinary macroprolactinomas?
Etual Espinosa1, Ernesto Sosa2, Victoria Mendoza3
1Experimental Endocrinology Unit, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México City, Mexico.
Endocrine
|November 13, 2015
Summary
Giant prolactinomas (gPRLomas), defined by large size and high PRL levels, share similar clinical behavior to non-giant prolactinomas. These rare tumors respond well to cabergoline treatment, with surgery rarely needed.
Area of Science:
- Endocrinology
- Neurosurgery
- Oncology
Background:
- Giant prolactinomas (gPRLomas) are rare lactotroph tumors (>4 cm, PRL >1000 ng/mL).
- Their clinical spectrum and comparison to non-giant prolactinomas require characterization.
Purpose of the Study:
- To characterize the clinical spectrum of gPRLomas.
- To compare gPRLomas with non-giant prolactinomas.
- To evaluate treatment response to dopamine agonists.
Main Methods:
- Retrospective study at a referral center.
- Data from 292 prolactinoma patients (2008-2015) analyzed.
- Focus on clinical, biochemical, and tumor volume characteristics, and treatment response.
Main Results:
- 47 patients (16%) had gPRLomas (42 males); common symptoms included visual defects and headache.
- Median PRL: 6667 ng/mL; median tumor volume: 32 cm³; 87% had hypogonadotropic hypogonadism.
- Cabergoline normalized PRL in 68% and reduced tumor volume >50% in 87% of gPRLoma patients.
Conclusions:
- Giant prolactinomas exhibit similar clinical behavior to macroprolactinomas.
- Cabergoline is highly effective, achieving treatment goals in 55% of gPRLoma patients.
- Pituitary surgery is seldom required for gPRLomas.
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