Soner Cander1, Ozen Oz Gul2, Eda Eylemer3, Elif Gullulu Boz3, Elif Gunes4, Bahattin Hakyemez5, Selcuk Yilmazlar6, Canan Ersoy2. 1. Endocrinology and Metabolism, Bursa Uludag University Medical School, Bursa, Turkey. drcander@gmail.com. 2. Endocrinology and Metabolism, Bursa Uludag University Medical School, Bursa, Turkey. 3. Internal Medicine, Bursa Uludag University Medical School, Bursa, Turkey. 4. Endocrinology and Metabolism, Bursa City Hospital, Bursa, Turkey. 5. Bursa Uludag University Medical School, Neuroradiology, , Turkey. 6. Bursa Uludag University Medical School, Neurosurgery, , Turkey.
Abstract
PURPOSE: Giant prolactinomas, which have extremely large sizes and high prolactin (PRL) values, are rarely seen. Although medical therapy is effective, surgical treatment is more frequently applied due to slightly lower response rates and compression symptoms. This study aimed to compare the medical and surgical treatment results in giant prolactinomas. METHODS: Thirty-nine patients who were followed up in our center for giant prolactinoma were included in the study, and the response rates of the patients were evaluated after the medical and surgical treatments. The treatment responses were compared in terms of tumor volume, PRL level, visual field, and pituitary function. RESULTS: The outcomes of the 66 treatment periods (medical n = 42; surgical n = 24) in 39 patients (mean age, 47.2 years; men, 89.7%) were evaluated. The most common presentations were hypogonadism and visual defects. The mean longest tumor diameter at diagnosis was 52.2 ± 11.8 mm, and the median PRL levels were 5000 ng/mL. PRL level normalization was achieved in 69% with medical therapy, and a curative response was obtained in only two patients with surgery. Tumor volume reduction was 67% (no cure) in the medical and 75% (13% cure) in the surgical groups (p = 0.39). Improvement of visual field was 70.8% in the medical and 84.2% in the surgical group (p = 0.12). CONCLUSION: In our study, it was observed that medical therapy was effective and safe in patients with giant prolactinomas. The use of surgical treatment should be limited to prolactinomas with compression or post-resistance to medical treatment in serious cases.
PURPOSE: Giant prolactinomas, which have extremely large sizes and high prolactin (PRL) values, are rarely seen. Although medical therapy is effective, surgical treatment is more frequently applied due to slightly lower response rates and compression symptoms. This study aimed to compare the medical and surgical treatment results in giant prolactinomas. METHODS: Thirty-nine patients who were followed up in our center for giant prolactinoma were included in the study, and the response rates of the patients were evaluated after the medical and surgical treatments. The treatment responses were compared in terms of tumor volume, PRL level, visual field, and pituitary function. RESULTS: The outcomes of the 66 treatment periods (medical n = 42; surgical n = 24) in 39 patients (mean age, 47.2 years; men, 89.7%) were evaluated. The most common presentations were hypogonadism and visual defects. The mean longest tumor diameter at diagnosis was 52.2 ± 11.8 mm, and the median PRL levels were 5000 ng/mL. PRL level normalization was achieved in 69% with medical therapy, and a curative response was obtained in only two patients with surgery. Tumor volume reduction was 67% (no cure) in the medical and 75% (13% cure) in the surgical groups (p = 0.39). Improvement of visual field was 70.8% in the medical and 84.2% in the surgical group (p = 0.12). CONCLUSION: In our study, it was observed that medical therapy was effective and safe in patients with giant prolactinomas. The use of surgical treatment should be limited to prolactinomas with compression or post-resistance to medical treatment in serious cases.
Authors: Shlomo Melmed; Felipe F Casanueva; Andrew R Hoffman; David L Kleinberg; Victor M Montori; Janet A Schlechte; John A H Wass Journal: J Clin Endocrinol Metab Date: 2011-02 Impact factor: 5.958
Authors: 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 F Young; Irina Bancos Journal: Endocr Pract Date: 2019-04 Impact factor: 3.443
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