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Long-term Follow-up of 84 Patients With Giant Prolactinomas—A Swedish Nationwide Study
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 Regi...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10655522/ https://www.ncbi.nlm.nih.gov/pubmed/37403202 http://dx.doi.org/10.1210/clinem/dgad393 |
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author | Himonakos, Christos Burman, Pia Borg, Henrik Dahlqvist, Per Engström, Britt Edén Ekman, Bertil Emilsson, Louise Olsson, Daniel S Ragnarsson, Oskar Wahlberg, Jeanette Åkerman, Anna-Karin Höybye, Charlotte Berinder, Katarina |
author_facet | Himonakos, Christos Burman, Pia Borg, Henrik Dahlqvist, Per Engström, Britt Edén Ekman, Bertil Emilsson, Louise Olsson, Daniel S Ragnarsson, Oskar Wahlberg, Jeanette Åkerman, Anna-Karin Höybye, Charlotte Berinder, Katarina |
author_sort | Himonakos, Christos |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-10655522 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-106555222023-07-04 Long-term Follow-up of 84 Patients With Giant Prolactinomas—A Swedish Nationwide Study Himonakos, Christos Burman, Pia Borg, Henrik Dahlqvist, Per Engström, Britt Edén Ekman, Bertil Emilsson, Louise Olsson, Daniel S Ragnarsson, Oskar Wahlberg, Jeanette Åkerman, Anna-Karin Höybye, Charlotte Berinder, Katarina J Clin Endocrinol Metab Clinical Research Article 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. Oxford University Press 2023-07-04 /pmc/articles/PMC10655522/ /pubmed/37403202 http://dx.doi.org/10.1210/clinem/dgad393 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of the Endocrine Society. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Clinical Research Article Himonakos, Christos Burman, Pia Borg, Henrik Dahlqvist, Per Engström, Britt Edén Ekman, Bertil Emilsson, Louise Olsson, Daniel S Ragnarsson, Oskar Wahlberg, Jeanette Åkerman, Anna-Karin Höybye, Charlotte Berinder, Katarina Long-term Follow-up of 84 Patients With Giant Prolactinomas—A Swedish Nationwide Study |
title | Long-term Follow-up of 84 Patients With Giant Prolactinomas—A Swedish Nationwide Study |
title_full | Long-term Follow-up of 84 Patients With Giant Prolactinomas—A Swedish Nationwide Study |
title_fullStr | Long-term Follow-up of 84 Patients With Giant Prolactinomas—A Swedish Nationwide Study |
title_full_unstemmed | Long-term Follow-up of 84 Patients With Giant Prolactinomas—A Swedish Nationwide Study |
title_short | Long-term Follow-up of 84 Patients With Giant Prolactinomas—A Swedish Nationwide Study |
title_sort | long-term follow-up of 84 patients with giant prolactinomas—a swedish nationwide study |
topic | Clinical Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10655522/ https://www.ncbi.nlm.nih.gov/pubmed/37403202 http://dx.doi.org/10.1210/clinem/dgad393 |
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