Extensive experience in the management of macroprolactinomas.

Abstract:

OBJECTIVES:Macroprolactinomas are pituitary tumours that can be managed with dopamine agonists (DA), surgery and radiotherapy. We aimed to assess the outcomes of these treatment modalities. DESIGN:Retrospective case-note study of patients managed in a single tertiary referral centre. PATIENTS:One hundred patients (68 male) diagnosed with macroprolactinoma between 1971 and 2009. MEASUREMENTS:We assessed the response to first-line treatment in terms of reduction in serum prolactin, endocrine status, symptomatic improvement and tumour shrinkage. Patients were divided into a group that received only DA therapy and a group that received surgery, radiotherapy or both, with or without a DA. We compared pituitary function at baseline and at last clinic visit between the two groups. RESULTS:In total, there were 1170 patient years of follow-up. Pituitary surgery was performed in 29/100 patients. Fourteen patients received pituitary radiotherapy (8/14 surgery also). At last clinic visit, the nonmedical therapy group had a higher risk of gonadotrophin deficiency (77·4% vs 44·8%, P = 0·0037), TSH deficiency (54·8% vs 25·4%, P = 0·0009) and ACTH deficiency (56·2% vs 17·2%, P = 0·0001). When last reviewed, 23/29 (79·3%) patients who underwent surgery and 10/14 (71·4%) patients who received radiotherapy were taking a DA. CONCLUSIONS:Treatment with a DA alone is associated with better outcomes in terms of pituitary function and as such represents the optimal first-line therapy for macroprolactinomas. Surgery and radiotherapy should be reserved for patients who are either intolerant of or resistant to DAs. Following surgery and/or radiotherapy, the majority of patients still require a DA for control of prolactin hypersecretion.

journal_name

Clin Endocrinol (Oxf)

journal_title

Clinical endocrinology

authors

Green AI,Sherlock M,Stewart PM,Gittoes NJ,Toogood AA

doi

10.1111/cen.12418

subject

Has Abstract

pub_date

2014-07-01 00:00:00

pages

85-92

issue

1

eissn

0300-0664

issn

1365-2265

journal_volume

81

pub_type

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