title: Treatment of clinically nonfunctioning pituitary adenomas with dopamine agonists.
abstract: OBJECTIVE
  Clinically nonfunctioning pituitary adenoma (NFPA) remains the only pituitary tumor subtype for which no effective medical therapy is available or recommended. We evaluated dopamine agonist (DA) therapy for preventing growth of postsurgical pituitary tumor remnants.
  
  
  METHODS
  The study design included historical cohort analysis of clinical results at two pituitary referral centers with different standard practices for postoperative NFPA management: DA therapy or conservative follow-up.
  
  
  METHODS
  Seventy-nine patients followed for 8.8±6.5 years were treated with DA, initiated upon residual tumor detection on postoperative MRI (preventive treatment (PT) group, n=55), or when tumor growth was subsequently detected during follow-up (remedial treatment (RT) group, n=24). The control group (n=60) received no medication. Tumoral dopamine and estrogen receptor expression assessed by quantitative RT-PCR and immunostaining were correlated with response to treatment.
  
  
  RESULTS
  Tumor mass decreased, remained stable, or enlarged, respectively, in 38, 49, and 13% of patients in the PT group, and in 0, 53, and 47% of control subjects; shrinkage or stabilization was achieved in 58% of enlarging tumors in the RT group, P < 0.0001.Fifteen-year progression-free survival rate was 0.805, 0.24, and 0.04, respectively, for PT, RT, and control groups (P<0.001). About 42% of patients in the control group required additional surgery or radiotherapy, compared with 38 and 13% subjects in the RT and PT groups, respectively (P=0.002). Outcome measures were not related to NFPA D2R abundance.
  
  
  CONCLUSIONS
  Dopamine agonist therapy in patients with NFPA is associated with decreased prevalence of residual tumor enlargement after transsphenoidal surgical resection.
authors.affiliation: Institute of Endocrinology, Metabolism and HypertensionTel Aviv Sourasky Medical Center, Tel Aviv, Israel Sackler Faculty of MedicineTel Aviv University, Tel Aviv, Israel yonagr@tlvmc.gov.il.
authors.forename: Y
authors.initials: Y
authors.lastname: Greenman
authors.affiliation: Pituitary CenterCedars Sinai Medical Center, Los Angeles, California, USA.
authors.forename: O
authors.initials: O
authors.lastname: Cooper
authors.affiliation: Institute of Endocrinology, Metabolism and HypertensionTel Aviv Sourasky Medical Center, Tel Aviv, Israel.
authors.forename: I
authors.initials: I
authors.lastname: Yaish
authors.affiliation: Institute of Endocrinology and MetabolismRabin Medical Center, Petah Tikva, Israel Sackler Faculty of MedicineTel Aviv University, Tel Aviv, Israel.
authors.forename: E
authors.initials: E
authors.lastname: Robenshtok
authors.affiliation: Institute of Endocrinology, Metabolism and HypertensionTel Aviv Sourasky Medical Center, Tel Aviv, Israel.
authors.forename: N
authors.initials: N
authors.lastname: Sagiv
authors.affiliation: Neuroradiology UnitTel Aviv Sourasky Medical Center, Tel Aviv, Israel Sackler Faculty of MedicineTel Aviv University, Tel Aviv, Israel.
authors.forename: T
authors.initials: T
authors.lastname: Jonas-Kimchi
authors.affiliation: Department of PathologyCedars Sinai Medical Center, Los Angeles, California, USA.
authors.forename: X
authors.initials: X
authors.lastname: Yuan
authors.affiliation: Department of PathologyCedars Sinai Medical Center, Los Angeles, California, USA.
authors.forename: A
authors.initials: A
authors.lastname: Gertych
authors.affiliation: Institute of Endocrinology and MetabolismRabin Medical Center, Petah Tikva, Israel Sackler Faculty of MedicineTel Aviv University, Tel Aviv, Israel.
authors.forename: I
authors.initials: I
authors.lastname: Shimon
authors.affiliation: Department of NeurosurgeryTel Aviv Sourasky Medical Center, Tel Aviv, Israel Sackler Faculty of MedicineTel Aviv University, Tel Aviv, Israel.
authors.forename: Z
authors.initials: Z
authors.lastname: Ram
authors.affiliation: Pituitary CenterCedars Sinai Medical Center, Los Angeles, California, USA.
authors.forename: S
authors.initials: S
authors.lastname: Melmed
authors.affiliation: Institute of Endocrinology, Metabolism and HypertensionTel Aviv Sourasky Medical Center, Tel Aviv, Israel Sackler Faculty of MedicineTel Aviv University, Tel Aviv, Israel.
authors.forename: N
authors.initials: N
authors.lastname: Stern
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000378:metabolism; D000328:Adult; D000368:Aged; D001971:Bromocriptine / Q000627:therapeutic use*; D000077465:Cabergoline; D018450:Disease Progression; D018491:Dopamine Agonists / Q000627:therapeutic use*; D004873:Ergolines / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000378:metabolism; D011954:Receptors, Dopamine / Q000378:metabolism; D011960:Receptors, Estrogen / Q000378:metabolism; D016896:Treatment Outcome
chemical_list: D018491:Dopamine Agonists; D004873:Ergolines; D011954:Receptors, Dopamine; D011960:Receptors, Estrogen; D001971:Bromocriptine; D000077465:Cabergoline