Ernesto Sosa-Eroza1, Etual Espinosa1, Claudia Ramírez-Rentería1, Victoria Mendoza1, Rocío Arreola2, Moises Mercado3. 1. Endocrinology Service and the Experimental Endocrinology Unit, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, MX, USA. 2. Pathology Department, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, MX, USA. 3. Endocrinology Service and the Experimental Endocrinology Unit, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, MX, USA. moises.mercado@endocrinologia.org.mx.
Abstract
BACKGROUND AND OBJECTIVES: Dopamine agonist (DA)-resistant prolactinomas are rare but they constitute a real challenge, since there are few therapeutic alternatives left for these patients. DESIGN AND SETTING: Proof-of-concept study at a tertiary care, referral center. PATIENTS AND METHODS: The studied population consisted of five patients (one female and four males, mean age at diagnosis 23.5 ± 19) with macroprolactinomas with persistent hyperprolactinemia and/or tumor mass despite high doses of cabergoline (CBG) and pituitary surgery, to whom 20 mg monthly of octreotide LAR was added for 6-13 months. Response was evaluated by measuring prolactin (PRL) levels and by magnetic resonance imaging. Immunohistochemistry (IHC) for pituitary hormones, Ki-67, and somatostatin receptor subtypes 2 and 5 was (SSTR2 and 5) was available in two of the subjects. RESULTS: The addition of octreotide LAR to ongoing CBG treatment had no effect on either PRL levels or tumor size in three patients. In two of the five patients, combination treatment resulted in a significant reduction in PRL concentrations (from 7643 to 200 ng/mL and from 2587 to 470 ng/mL) as well as in adenoma size (93% reduction). IHC evaluation of tumor samples from two patients (a responder and a non-responder) revealed positive immunostaining for PRL and SSTR5 but not for other pituitary hormones or for SSTR2. CONCLUSIONS: The addition of a somatostatin analog to ongoing CBG treatment may be effective in some patients with DA-resistant macroprolactinomas, independently of the adenoma's SSTR expression profile.
BACKGROUND AND OBJECTIVES:Dopamine agonist (DA)-resistant prolactinomas are rare but they constitute a real challenge, since there are few therapeutic alternatives left for these patients. DESIGN AND SETTING: Proof-of-concept study at a tertiary care, referral center. PATIENTS AND METHODS: The studied population consisted of five patients (one female and four males, mean age at diagnosis 23.5 ± 19) with macroprolactinomas with persistent hyperprolactinemia and/or tumor mass despite high doses of cabergoline (CBG) and pituitary surgery, to whom 20 mg monthly of octreotideLAR was added for 6-13 months. Response was evaluated by measuring prolactin (PRL) levels and by magnetic resonance imaging. Immunohistochemistry (IHC) for pituitary hormones, Ki-67, and somatostatin receptor subtypes 2 and 5 was (SSTR2 and 5) was available in two of the subjects. RESULTS: The addition of octreotideLAR to ongoing CBG treatment had no effect on either PRL levels or tumor size in three patients. In two of the five patients, combination treatment resulted in a significant reduction in PRL concentrations (from 7643 to 200 ng/mL and from 2587 to 470 ng/mL) as well as in adenoma size (93% reduction). IHC evaluation of tumor samples from two patients (a responder and a non-responder) revealed positive immunostaining for PRL and SSTR5 but not for other pituitary hormones or for SSTR2. CONCLUSIONS: The addition of a somatostatin analog to ongoing CBG treatment may be effective in some patients with DA-resistant macroprolactinomas, independently of the adenoma's SSTR expression profile.
Authors: S Grottoli; V Gasco; F Broglio; R Baldelli; F Ragazzoni; F Gallenca; A Mainolfi; F Prodam; G Muccioli; E Ghigo Journal: J Clin Endocrinol Metab Date: 2006-01-31 Impact factor: 5.958
Authors: P Jaquet; L Ouafik; A Saveanu; G Gunz; F Fina; H Dufour; M D Culler; J P Moreau; A Enjalbert Journal: J Clin Endocrinol Metab Date: 1999-09 Impact factor: 5.958
Authors: Ilan Shimon; Ernesto Sosa; Victoria Mendoza; Yona Greenman; Amit Tirosh; Etual Espinosa; Vera Popovic; Andrea Glezer; Marcello D Bronstein; Moises Mercado Journal: Pituitary Date: 2016-08 Impact factor: 4.107
Authors: A Liuzzi; D Dallabonzana; G Oppizzi; G G Verde; R Cozzi; P Chiodini; G Luccarelli Journal: N Engl J Med Date: 1985-09-12 Impact factor: 91.245
Authors: Federico Gatto; Richard A Feelders; Rob van der Pas; Johan M Kros; Marlijn Waaijers; Diana Sprij-Mooij; Sebastian J C M M Neggers; Aart-Jan van der Lelij; Francesco Minuto; Steven W J Lamberts; Wouter W de Herder; Diego Ferone; Leo J Hofland Journal: J Clin Endocrinol Metab Date: 2012-11-01 Impact factor: 5.958
Authors: J Webster; G Piscitelli; A Polli; A D'Alberton; L Falsetti; C Ferrari; P Fioretti; G Giordano; M L'Hermite; E Ciccarelli Journal: Clin Endocrinol (Oxf) Date: 1993-09 Impact factor: 3.478
Authors: Maria de Fátima de Magalhães Gonzaga; Lucas Faria de Castro; Luciana Ansaneli Naves; José Luiz Mendonça; Benicio Oton de Lima; Iruena Kessler; Luiz Augusto Casulari Journal: Front Endocrinol (Lausanne) Date: 2018-11-13 Impact factor: 5.555
Authors: Renato Cozzi; Maria Rosaria Ambrosio; Roberto Attanasio; Claudia Battista; Alessandro Bozzao; Marco Caputo; Enrica Ciccarelli; Laura De Marinis; Ernesto De Menis; Marco Faustini Fustini; Franco Grimaldi; Andrea Lania; Giovanni Lasio; Francesco Logoluso; Marco Losa; Pietro Maffei; Davide Milani; Maurizio Poggi; Michele Zini; Laurence Katznelson; Anton Luger; Catalina Poiana Journal: Eur J Endocrinol Date: 2022-02-03 Impact factor: 6.664
Authors: L Andereggen; J Frey; R H Andres; M M Luedi; M El-Koussy; H R Widmer; J Beck; L Mariani; R W Seiler; E Christ Journal: J Endocrinol Invest Date: 2021-04-13 Impact factor: 4.256