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Long-term outcome of macroprolactinomas
Lori Képénékian1, Hélène Cebula2, Frédéric Castinetti3
1Service de médecine interne, nutrition et endocrinologie, hôpital de Hautepierre, University Hospital of Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France.
Annales D'Endocrinologie
|September 20, 2016
Summary
Dopamine agonists (DA) effectively manage macroprolactinomas, a chronic condition. Long-term outcomes show most patients achieve control, but potential adverse effects necessitate revisiting treatment strategies for optimal prognosis.
Area of Science:
- Endocrinology
- Oncology
- Neurosurgery
Background:
- Macroprolactinomas, large pituitary tumors secreting prolactin, have seen a shift in management from surgery to dopamine agonists (DA).
- Limited data exist on the long-term outcomes of patients with macroprolactinomas treated with DA.
Purpose of the Study:
- To evaluate the long-term outcomes of macroprolactinoma management.
- To assess the efficacy and safety of dopamine agonists in a large cohort over an extended period.
Main Methods:
- A retrospective, descriptive, multicenter study included 48 patients with macroprolactinoma.
- Patients were followed for a minimum of 5 years (mean follow-up: 196 months) between 1973 and 2008.
- Data included baseline characteristics, treatment modalities (medical, surgical, radiotherapy), and long-term outcomes.
Main Results:
- At long-term follow-up, 20.8% of patients were cured, 68.8% were controlled, and 10.4% remained uncontrolled.
- Uncontrolled macroprolactinomas were associated with higher baseline prolactin levels and cumulative cabergoline doses.
- No significant increase in hypopituitarism was observed; two patients developed valvular heart disease.
Conclusions:
- Macroprolactinoma is often a chronic disease manageable with dopamine agonists.
- Uncertainty regarding long-term adverse effects of high cumulative DA doses warrants re-evaluation of current treatment strategies.
- The role of combined surgical and medical treatment for macroprolactinomas requires further investigation.
