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Long-term Follow-up of 84 Patients With Giant Prolactinomas-A Swedish Nationwide Study

Himonakos, Christos ; Burman, Pia LU ; Borg, Henrik LU ; Dahlqvist, Per ; Engström, Britt Edén ; Ekman, Bertil ; Emilsson, Louise ; Olsson, Daniel S. ; Ragnarsson, Oskar and Wahlberg, Jeanette , et al. (2023) In The Journal of clinical endocrinology and metabolism 108(12). p.1506-1514
Abstract

PURPOSE: To describe the clinical presentation and treatment outcomes in a nationwide cohort of patients with giant prolactinomas. METHODS: Register-based study of patients with giant prolactinomas [serum prolactin (PRL) > 1000 µg/L, tumor diameter ≥40 mm] identified in the Swedish Pituitary Register 1991-2018. RESULTS: Eighty-four patients [mean age 47 (SD ±16) years, 89% men] were included in the study. At diagnosis, the median PRL was 6305 µg/L (range 1450-253 000), the median tumor diameter was 47 mm (range 40-85), 84% of the patients had hypogonadotropic hypogonadism, and 71% visual field defects. All patients were treated with a dopamine agonist (DA) at some point. Twenty-three (27%) received 1 or more additional therapies,... (More)

PURPOSE: To describe the clinical presentation and treatment outcomes in a nationwide cohort of patients with giant prolactinomas. METHODS: Register-based study of patients with giant prolactinomas [serum prolactin (PRL) > 1000 µg/L, tumor diameter ≥40 mm] identified in the Swedish Pituitary Register 1991-2018. RESULTS: Eighty-four patients [mean age 47 (SD ±16) years, 89% men] were included in the study. At diagnosis, the median PRL was 6305 µg/L (range 1450-253 000), the median tumor diameter was 47 mm (range 40-85), 84% of the patients had hypogonadotropic hypogonadism, and 71% visual field defects. All patients were treated with a dopamine agonist (DA) at some point. Twenty-three (27%) received 1 or more additional therapies, including surgery (n = 19), radiotherapy (n = 6), other medical treatments (n = 4), and chemotherapy (n = 2). Ki-67 was ≥10% in 4/14 tumors. At the last follow-up [median 9 years (interquartile range (IQR) 4-15)], the median PRL was 12 µg/L (IQR 4-126), and the median tumor diameter was 22 mm (IQR 3-40). Normalized PRL was achieved in 55%, significant tumor reduction in 69%, and combined response (normalized PRL and significant tumor reduction) in 43%. In the primary DA-treated patients (n = 79), the reduction in PRL or tumor size after the first year predicted the combined response at the last follow-up (P < .001 and P = .012, respectively). CONCLUSION: DAs effectively reduced PRL and tumor size, but approximately 1 patient out of 4 needed multimodal treatment. Our results suggest that the response to DA after 1 year is useful for identifying patients who need more careful monitoring and, in some cases, additional treatment.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
dopamine agonist resistance, dopamine agonists, giant prolactinomas, Ki-67, long-term follow-up
in
The Journal of clinical endocrinology and metabolism
volume
108
issue
12
pages
1506 - 1514
publisher
Oxford University Press
external identifiers
  • pmid:37403202
  • scopus:85178498966
ISSN
1945-7197
DOI
10.1210/clinem/dgad393
language
English
LU publication?
yes
additional info
´
id
1f30c0a0-692c-40b7-890c-f7001be1a45b
date added to LUP
2024-01-02 11:37:58
date last changed
2024-04-17 11:03:58
@article{1f30c0a0-692c-40b7-890c-f7001be1a45b,
  abstract     = {{<p>PURPOSE: To describe the clinical presentation and treatment outcomes in a nationwide cohort of patients with giant prolactinomas. METHODS: Register-based study of patients with giant prolactinomas [serum prolactin (PRL) &gt; 1000 µg/L, tumor diameter ≥40 mm] identified in the Swedish Pituitary Register 1991-2018. RESULTS: Eighty-four patients [mean age 47 (SD ±16) years, 89% men] were included in the study. At diagnosis, the median PRL was 6305 µg/L (range 1450-253 000), the median tumor diameter was 47 mm (range 40-85), 84% of the patients had hypogonadotropic hypogonadism, and 71% visual field defects. All patients were treated with a dopamine agonist (DA) at some point. Twenty-three (27%) received 1 or more additional therapies, including surgery (n = 19), radiotherapy (n = 6), other medical treatments (n = 4), and chemotherapy (n = 2). Ki-67 was ≥10% in 4/14 tumors. At the last follow-up [median 9 years (interquartile range (IQR) 4-15)], the median PRL was 12 µg/L (IQR 4-126), and the median tumor diameter was 22 mm (IQR 3-40). Normalized PRL was achieved in 55%, significant tumor reduction in 69%, and combined response (normalized PRL and significant tumor reduction) in 43%. In the primary DA-treated patients (n = 79), the reduction in PRL or tumor size after the first year predicted the combined response at the last follow-up (P &lt; .001 and P = .012, respectively). CONCLUSION: DAs effectively reduced PRL and tumor size, but approximately 1 patient out of 4 needed multimodal treatment. Our results suggest that the response to DA after 1 year is useful for identifying patients who need more careful monitoring and, in some cases, additional treatment.</p>}},
  author       = {{Himonakos, Christos and Burman, Pia and Borg, Henrik and Dahlqvist, Per and Engström, Britt Edén and Ekman, Bertil and Emilsson, Louise and Olsson, Daniel S. and Ragnarsson, Oskar and Wahlberg, Jeanette and Åkerman, Anna Karin and Höybye, Charlotte and Berinder, Katarina}},
  issn         = {{1945-7197}},
  keywords     = {{dopamine agonist resistance; dopamine agonists; giant prolactinomas; Ki-67; long-term follow-up}},
  language     = {{eng}},
  month        = {{11}},
  number       = {{12}},
  pages        = {{1506--1514}},
  publisher    = {{Oxford University Press}},
  series       = {{The Journal of clinical endocrinology and metabolism}},
  title        = {{Long-term Follow-up of 84 Patients With Giant Prolactinomas-A Swedish Nationwide Study}},
  url          = {{http://dx.doi.org/10.1210/clinem/dgad393}},
  doi          = {{10.1210/clinem/dgad393}},
  volume       = {{108}},
  year         = {{2023}},
}