Management and outcomes of giant prolactinoma: A series of 71 patients

Oksana Hamidi, Jamie Van Gompel, Lucinda Gruber, Nana Esi Kittah, Diane Donegan, Kenneth A. Philbrick, Kelly K. Koeller, Dana Erickson, Neena Natt, Todd B. Nippoldt, William Francis Young, Irina Bancos

Research output: Contribution to journalArticle

5 Scopus citations

Abstract

Objective: To describe outcomes of patients with giant prolactinoma (≥4 cm) and identify predictors of therapeutic response. Methods: In this retrospective study, complete biochemical and structural response were defined as prolactin (PRL) ≤25 ng/mL and no visible tumor at follow-up, respectively. Results: Giant prolactinoma (median size, 4.8 cm [range, 4 to 9.8 cm]; median PRL, 5,927 ng/mL [range, 120 to 100,000 ng/mL]) was diagnosed in 71 patients. Treatments included: Dopamine agonists (DAs) (n = 70, 99%), surgery (n = 30, 42%), radiation (n = 10, 14%), and somatostatin analogs (n = 2, 3%). Patients treated with DA monotherapy were older compared with those who received subsequent therapies (47 years vs. 28 years; P = .003) but had similar initial PRL and tumor size. Surgically managed patients were younger compared with the nonsurgical group (35 years vs. 46 years; P = .02) and had lower initial PRL (3,121 ng/mL vs. 6,920 ng/mL; P = .02), yet they had similar tumor response. Hypopituitarism was more common following surgery compared to medical management: Adrenal insufficiency (69% vs. 27%; P<.001), hypothyroidism (67% vs. 38%; P = .02), growth hormone deficiency (24% vs. 6%; P = .04), and diabetes insipidus (17% vs. 3%; P = .04). Therapeutic response did not correlate with sex, age, initial PRL, tumor size, or first-line therapy mode. At median follow-up of 4.8 years, the median PRL was 18.3 ng/mL (range, 0.6 to 12,680 ng/mL), and final volume was 0.9 cm3 (range, 0 to 43.0 cm3). In those with available data, 36/65 (55%) patients achieved PRL normalization, and 16/61 (26%) had no visible tumor at follow-up. Conclusion: Most patients with giant prolactinoma have excellent response to DA. Sex, age, initial PRL, and tumor size do not predict therapeutic response.

Original languageEnglish (US)
Pages (from-to)340-352
Number of pages13
JournalEndocrine Practice
Volume25
Issue number4
DOIs
StatePublished - Apr 1 2019

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

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    Hamidi, O., Van Gompel, J., Gruber, L., Kittah, N. E., Donegan, D., Philbrick, K. A., Koeller, K. K., Erickson, D., Natt, N., Nippoldt, T. B., Young, W. F., & Bancos, I. (2019). Management and outcomes of giant prolactinoma: A series of 71 patients. Endocrine Practice, 25(4), 340-352. https://doi.org/10.4158/EP-2018-0392