Radiographic and Hormonal Regression in Prolactinomas: An Analysis of Treatment Failure

Oluwaseun O. Akinduro, Victor M. Lu, Alessandro Izzo, Gaetano De Biase, George Vilanilam, Jamie J. Van Gompel, Victor Bernet, Angela Donaldson, Osarenoma Olomu, Fredric B. Meyer, Alfredo Quinones-Hinojosa, Kaisorn L. Chaichana

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objective: First-line treatment for prolactin-producing pituitary adenomas is dopamine agonist (DA) therapy. This is the first study to analyze the rate of radiographic and hormonal regression of prolactinomas in response to DA therapy to better understand what time frame we consider DA treatment failure. Methods: We searched the electronic medical records of 3 tertiary care medical institutions for patients with prolactinomas. The primary outcome was tumor volume and prolactin (PRL) levels at various time points. The secondary outcome was indicators of treatment failure. Modeling by both linear and exponential models was tested to determine potential predictors of response magnitude and treatment failure by multivariate and regression analyses respectively. Results: There were 99 patients (53% male) included in this analysis. The mean patient age was 42.7 years ± 14.5, and mean width/volume of tumor at diagnosis was 12.3 mm and 1.3 cm3, respectively. The mean PRL level at diagnosis was 593.2 ng/mL (79–7913). Modeling indicated a plateau at 68.2% initial volume (95% confidence interval 61.7–73.5) by 12.6 months and a PRL plateau of 21.4 ng/mL (95% confidence interval 0–92.5) by 3.3 months. Multivariate analyses revealed male sex (odds ratio 0.168; P = 0.036) to be a predictor of faster PRL response to DA therapy. Conclusions: Prolactinomas plateau in PRL levels and the rate of size regression within the first year of DA treatment. Prolactinomas with lack of size regression and failure to reach normalization of PRL levels by 12 months may be considered for other management strategies.

Original languageEnglish (US)
JournalWorld neurosurgery
DOIs
StatePublished - Jan 1 2019

Fingerprint

Prolactinoma
Treatment Failure
Prolactin
Dopamine Agonists
Tumor Burden
Multivariate Analysis
Confidence Intervals
Therapeutics
Electronic Health Records
Sex Ratio
Tertiary Healthcare
Linear Models
Odds Ratio
Regression Analysis

Keywords

  • Bromocriptine
  • Cabergoline
  • Dopamine agonist
  • Pituitary adenoma
  • Prolactinoma

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Radiographic and Hormonal Regression in Prolactinomas : An Analysis of Treatment Failure. / Akinduro, Oluwaseun O.; Lu, Victor M.; Izzo, Alessandro; De Biase, Gaetano; Vilanilam, George; Van Gompel, Jamie J.; Bernet, Victor; Donaldson, Angela; Olomu, Osarenoma; Meyer, Fredric B.; Quinones-Hinojosa, Alfredo; Chaichana, Kaisorn L.

In: World neurosurgery, 01.01.2019.

Research output: Contribution to journalArticle

Akinduro, OO, Lu, VM, Izzo, A, De Biase, G, Vilanilam, G, Van Gompel, JJ, Bernet, V, Donaldson, A, Olomu, O, Meyer, FB, Quinones-Hinojosa, A & Chaichana, KL 2019, 'Radiographic and Hormonal Regression in Prolactinomas: An Analysis of Treatment Failure', World neurosurgery. https://doi.org/10.1016/j.wneu.2019.05.249
Akinduro, Oluwaseun O. ; Lu, Victor M. ; Izzo, Alessandro ; De Biase, Gaetano ; Vilanilam, George ; Van Gompel, Jamie J. ; Bernet, Victor ; Donaldson, Angela ; Olomu, Osarenoma ; Meyer, Fredric B. ; Quinones-Hinojosa, Alfredo ; Chaichana, Kaisorn L. / Radiographic and Hormonal Regression in Prolactinomas : An Analysis of Treatment Failure. In: World neurosurgery. 2019.
@article{a159a4c222a14f719e711c90886caa60,
title = "Radiographic and Hormonal Regression in Prolactinomas: An Analysis of Treatment Failure",
abstract = "Objective: First-line treatment for prolactin-producing pituitary adenomas is dopamine agonist (DA) therapy. This is the first study to analyze the rate of radiographic and hormonal regression of prolactinomas in response to DA therapy to better understand what time frame we consider DA treatment failure. Methods: We searched the electronic medical records of 3 tertiary care medical institutions for patients with prolactinomas. The primary outcome was tumor volume and prolactin (PRL) levels at various time points. The secondary outcome was indicators of treatment failure. Modeling by both linear and exponential models was tested to determine potential predictors of response magnitude and treatment failure by multivariate and regression analyses respectively. Results: There were 99 patients (53{\%} male) included in this analysis. The mean patient age was 42.7 years ± 14.5, and mean width/volume of tumor at diagnosis was 12.3 mm and 1.3 cm3, respectively. The mean PRL level at diagnosis was 593.2 ng/mL (79–7913). Modeling indicated a plateau at 68.2{\%} initial volume (95{\%} confidence interval 61.7–73.5) by 12.6 months and a PRL plateau of 21.4 ng/mL (95{\%} confidence interval 0–92.5) by 3.3 months. Multivariate analyses revealed male sex (odds ratio 0.168; P = 0.036) to be a predictor of faster PRL response to DA therapy. Conclusions: Prolactinomas plateau in PRL levels and the rate of size regression within the first year of DA treatment. Prolactinomas with lack of size regression and failure to reach normalization of PRL levels by 12 months may be considered for other management strategies.",
keywords = "Bromocriptine, Cabergoline, Dopamine agonist, Pituitary adenoma, Prolactinoma",
author = "Akinduro, {Oluwaseun O.} and Lu, {Victor M.} and Alessandro Izzo and {De Biase}, Gaetano and George Vilanilam and {Van Gompel}, {Jamie J.} and Victor Bernet and Angela Donaldson and Osarenoma Olomu and Meyer, {Fredric B.} and Alfredo Quinones-Hinojosa and Chaichana, {Kaisorn L.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.wneu.2019.05.249",
language = "English (US)",
journal = "World Neurosurgery",
issn = "1878-8750",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Radiographic and Hormonal Regression in Prolactinomas

T2 - An Analysis of Treatment Failure

AU - Akinduro, Oluwaseun O.

AU - Lu, Victor M.

AU - Izzo, Alessandro

AU - De Biase, Gaetano

AU - Vilanilam, George

AU - Van Gompel, Jamie J.

AU - Bernet, Victor

AU - Donaldson, Angela

AU - Olomu, Osarenoma

AU - Meyer, Fredric B.

AU - Quinones-Hinojosa, Alfredo

AU - Chaichana, Kaisorn L.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective: First-line treatment for prolactin-producing pituitary adenomas is dopamine agonist (DA) therapy. This is the first study to analyze the rate of radiographic and hormonal regression of prolactinomas in response to DA therapy to better understand what time frame we consider DA treatment failure. Methods: We searched the electronic medical records of 3 tertiary care medical institutions for patients with prolactinomas. The primary outcome was tumor volume and prolactin (PRL) levels at various time points. The secondary outcome was indicators of treatment failure. Modeling by both linear and exponential models was tested to determine potential predictors of response magnitude and treatment failure by multivariate and regression analyses respectively. Results: There were 99 patients (53% male) included in this analysis. The mean patient age was 42.7 years ± 14.5, and mean width/volume of tumor at diagnosis was 12.3 mm and 1.3 cm3, respectively. The mean PRL level at diagnosis was 593.2 ng/mL (79–7913). Modeling indicated a plateau at 68.2% initial volume (95% confidence interval 61.7–73.5) by 12.6 months and a PRL plateau of 21.4 ng/mL (95% confidence interval 0–92.5) by 3.3 months. Multivariate analyses revealed male sex (odds ratio 0.168; P = 0.036) to be a predictor of faster PRL response to DA therapy. Conclusions: Prolactinomas plateau in PRL levels and the rate of size regression within the first year of DA treatment. Prolactinomas with lack of size regression and failure to reach normalization of PRL levels by 12 months may be considered for other management strategies.

AB - Objective: First-line treatment for prolactin-producing pituitary adenomas is dopamine agonist (DA) therapy. This is the first study to analyze the rate of radiographic and hormonal regression of prolactinomas in response to DA therapy to better understand what time frame we consider DA treatment failure. Methods: We searched the electronic medical records of 3 tertiary care medical institutions for patients with prolactinomas. The primary outcome was tumor volume and prolactin (PRL) levels at various time points. The secondary outcome was indicators of treatment failure. Modeling by both linear and exponential models was tested to determine potential predictors of response magnitude and treatment failure by multivariate and regression analyses respectively. Results: There were 99 patients (53% male) included in this analysis. The mean patient age was 42.7 years ± 14.5, and mean width/volume of tumor at diagnosis was 12.3 mm and 1.3 cm3, respectively. The mean PRL level at diagnosis was 593.2 ng/mL (79–7913). Modeling indicated a plateau at 68.2% initial volume (95% confidence interval 61.7–73.5) by 12.6 months and a PRL plateau of 21.4 ng/mL (95% confidence interval 0–92.5) by 3.3 months. Multivariate analyses revealed male sex (odds ratio 0.168; P = 0.036) to be a predictor of faster PRL response to DA therapy. Conclusions: Prolactinomas plateau in PRL levels and the rate of size regression within the first year of DA treatment. Prolactinomas with lack of size regression and failure to reach normalization of PRL levels by 12 months may be considered for other management strategies.

KW - Bromocriptine

KW - Cabergoline

KW - Dopamine agonist

KW - Pituitary adenoma

KW - Prolactinoma

UR - http://www.scopus.com/inward/record.url?scp=85068087799&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85068087799&partnerID=8YFLogxK

U2 - 10.1016/j.wneu.2019.05.249

DO - 10.1016/j.wneu.2019.05.249

M3 - Article

C2 - 31181361

AN - SCOPUS:85068087799

JO - World Neurosurgery

JF - World Neurosurgery

SN - 1878-8750

ER -