Extensive experience in the management of macroprolactinomas.
OBJECTIVE
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.


METHODS
Retrospective case-note study of patients managed in a single tertiary referral centre.


METHODS
One hundred patients (68 male) diagnosed with macroprolactinoma between 1971 and 2009.


METHODS
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 DAs. Following surgery and/or radiotherapy, the majority of patients still require a DA for control of prolactin hypersecretion.
Department of Endocrinology, Queen Elizabeth Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK.
Anna I
AI
Green
Mark
M
Sherlock
Paul M
PM
Stewart
Neil J
NJ
Gittoes
Andrew A
AA
Toogood
D000293:Adolescent; D000328:Adult; D000368:Aged; D018491:Dopamine Agonists / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010902:Pituitary Gland / Q000187:drug effects / Q000473:pathology / Q000601:surgery; D010911:Pituitary Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000601:surgery*; D011388:Prolactin / Q000097:blood; D015175:Prolactinoma; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
D018491:Dopamine Agonists; D011388:Prolactin