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Extensive experience in the management of macroprolactinomas
Author(s) -
Green Anna I.,
Sherlock Mark,
Stewart Paul M.,
Gittoes Neil J.,
Toogood Andrew A.
Publication year - 2014
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/cen.12418
Subject(s) - medicine , radiation therapy , hypopituitarism , retrospective cohort study , pituitary adenoma , prolactin , surgery , adenoma , hormone
Summary Objectives Macroprolactinomas are pituitary tumours that can be managed with dopamine agonists ( DA ), surgery and radiotherapy. We aimed to assess the outcomes of these treatment modalities. Design Retrospective case‐note study of patients managed in a single tertiary referral centre. Patients One hundred patients (68 male) diagnosed with macroprolactinoma between 1971 and 2009. Measurements We assessed the response to first‐line treatment in terms of reduction in serum prolactin, endocrine status, symptomatic improvement and tumour shrinkage. Patients were divided into a group that received only DA therapy and a group that received surgery, radiotherapy or both, with or without a DA . We compared pituitary function at baseline and at last clinic visit between the two groups. Results In total, there were 1170 patient years of follow‐up. Pituitary surgery was performed in 29/100 patients. Fourteen patients received pituitary radiotherapy (8/14 surgery also). At last clinic visit, the nonmedical therapy group had a higher risk of gonadotrophin deficiency (77·4% vs 44·8%, P = 0·0037), TSH deficiency (54·8% vs 25·4%, P = 0·0009) and ACTH deficiency (56·2% vs 17·2%, P = 0·0001). When last reviewed, 23/29 (79·3%) patients who underwent surgery and 10/14 (71·4%) patients who received radiotherapy were taking a DA . Conclusions Treatment with a DA alone is associated with better outcomes in terms of pituitary function and as such represents the optimal first‐line therapy for macroprolactinomas. Surgery and radiotherapy should be reserved for patients who are either intolerant of or resistant to DA s. Following surgery and/or radiotherapy, the majority of patients still require a DA for control of prolactin hypersecretion.