title: Giant prolactinomas larger than 60 mm in size: a cohort of massive and aggressive prolactin-secreting pituitary adenomas.
abstract: OBJECTIVE
  Prolactin (PRL)-secreting macroadenomas usually measure between 10 and 40 mm. Giant (adenoma size ≥40 mm) PRL-tumors are not common, and larger prolactinomas (maximal diameter ≥60 mm) are rare, and their management outcomes have not been well characterized.
  
  
  METHODS
  We have identified 18 subjects (16 men, 2 females) with giant PRL-adenomas (size ≥60 mm; PRL > 1000 ng/ml) and summarized their characteristics and response to treatment.
  
  
  RESULTS
  Mean age was 36.3 ± 13.5 years (range 12-59 years). Mean adenoma size was 71.8 ± 10.2 mm (60-92 mm). Complaints at presentation included headaches in 11 patients, visual deterioration in 9, sexual dysfunction in 9 males, and behavioral changes in two. Fourteen (78 %) had visual field defects. Mean PRL at presentation was 28,465 ng/ml (range 1300-270,000). All patients were treated with cabergoline (3.9 ± 2.0 mg/week), except for one who received bromocriptine. Treatment achieved PRL normalization in 11/18 patients within a median interval of 20 months. Visual improvement occurred in 12/14 patients with pre-treatment visual abnormalities. Nine patients underwent surgery (transsphenoidal, 7; transcranial, 2). None of the seven patients with elevated PRL before surgery achieved remission post-operatively. After a follow-up of 7.8 ± 5.1 years, 15/18 patients had significant adenoma shrinkage. Eleven patients are normoprolactinemic, 3 are partially controlled (PRL < 3 × ULN), and 4 remain with significantly elevated PRL. Most patients reported disappearance or improvement of their complaints.
  
  
  CONCLUSIONS
  These enormous PRL-adenomas are invasive but respond fairly well to medical treatment. Long-term therapy with high dose cabergoline together with a pituitary surgery in some patients was the key for their successful management, achieving biochemical and clinical remission in most patients.
authors.affiliation: Institute of Endocrinology, Beilinson Hospital, Rabin Medical Center, 49100, Petah Tikva, Israel. ilanshi@clalit.org.il.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. ilanshi@clalit.org.il.
authors.forename: Ilan
authors.initials: I
authors.lastname: Shimon
authors.affiliation: Endocrinology Service, Hospital de Especialidades, Centro Médico Nacional S.XXI, IMSS, Mexico City, Mexico.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Sosa
authors.affiliation: Endocrinology Service, Hospital de Especialidades, Centro Médico Nacional S.XXI, IMSS, Mexico City, Mexico.
authors.forename: Victoria
authors.initials: V
authors.lastname: Mendoza
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.|Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv-Sourasky Medical Center, Tel Aviv, Israel.
authors.forename: Yona
authors.initials: Y
authors.lastname: Greenman
authors.affiliation: Institute of Endocrinology, Beilinson Hospital, Rabin Medical Center, 49100, Petah Tikva, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Amit
authors.initials: A
authors.lastname: Tirosh
authors.affiliation: Endocrinology Service, Hospital de Especialidades, Centro Médico Nacional S.XXI, IMSS, Mexico City, Mexico.
authors.forename: Etual
authors.initials: E
authors.lastname: Espinosa
authors.affiliation: University of Belgrade, School of Medicine, Belgrade, Serbia.
authors.forename: Vera
authors.initials: V
authors.lastname: Popovic
authors.affiliation: Neuroendocrine Unit, Division of Endocrinology and Metabolism, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Andrea
authors.initials: A
authors.lastname: Glezer
authors.affiliation: Neuroendocrine Unit, Division of Endocrinology and Metabolism, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Marcello D
authors.initials: MD
authors.lastname: Bronstein
authors.affiliation: Experimental Endocrinology Unit, Hospital de Especialidades, Centro Médico Nacional S.XXI, IMSS, Mexico City, Mexico.
authors.forename: Moises
authors.initials: M
authors.lastname: Mercado
mesh_terms: D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001971:Bromocriptine / Q000627:therapeutic use; D000077465:Cabergoline; D002648:Child; D004873:Ergolines / Q000627:therapeutic use; D005260:Female; D005687:Galactorrhea / Q000209:etiology; D006261:Headache / Q000209:etiology; D006727:Hormone Antagonists / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D010911:Pituitary Neoplasms / Q000150:complications / Q000473:pathology* / Q000628:therapy; D015175:Prolactinoma / Q000150:complications / Q000473:pathology* / Q000628:therapy; D012735:Sexual Dysfunction, Physiological / Q000209:etiology; D016896:Treatment Outcome; D047368:Tumor Burden; D014786:Vision Disorders / Q000209:etiology; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D004873:Ergolines; D006727:Hormone Antagonists; D001971:Bromocriptine; D000077465:Cabergoline
keywords: Cabergoline; Giant; Pituitary adenoma; Prolactin; Prolactinoma