title: Long-term outcome of macroprolactinomas.
abstract: OBJECTIVE
  Management of macroprolactinomas has dramatically changed in recent decades, from surgical to medical treatment as first-line therapy, with the development of dopamine agonists (DA). But few data exist on the long-term outcome of these patients.
  
  
  METHODS
  Retrospective descriptive multicenter study of patients with macroprolactinoma followed for at least 5 years between 1973 and 2008 at the University Hospitals of Strasbourg and Marseille.
  
  
  RESULTS
  Forty-eight patients were included with 27 men, hypopituitarism in 33.3% of all patients and mean serum prolactin (PRL) level at diagnosis 2218.2±4154.7μg/L. Among the patients, 58.3% received medical treatment, 25% had additional surgery and 12.5% surgery and radiotherapy. The mean follow-up duration was 196±100 months. At the end of follow-up, 10 patients (20.8%) were cured (i.e. normal PRL level and normal imaging, no symptoms and withdrawal of DA≥1 year), 33 (68.8%) were controlled (i.e. normal PRL level, normal or abnormal imaging, no symptoms, DA in progress) and 5 (10.4%) were uncontrolled. Uncontrolled patients had significant higher baseline PRL level (P=0.0412) and cabergoline cumulative dose (P=0.0065) compared to the controlled group. There was no increase in frequency of hypopituitarism. Clinically significant valvular heart disease was found in 2 patients but screening was not systematic.
  
  
  CONCLUSIONS
  Macroprolactinoma is currently most often a chronic disease controlled with DA. However, uncertainty about the adverse effects associated with high cumulative doses and the lack of data on the prognosis at very long-term should incite to revisit current strategies, including the role of surgery combined to medical treatment.
authors.affiliation: Service de médecine interne, nutrition et endocrinologie, hôpital de Hautepierre, University Hospital of Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France.
authors.forename: Lori
authors.initials: L
authors.lastname: Képénékian
authors.affiliation: Service de neurochirurgie, hôpital de Hautepierre, University Hospital of Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Cebula
authors.affiliation: CRN2M-UMR7286, service d'endocrinologie et centre de référence des maladies rares d'origine hypophysaire DEFHY, Aix-Marseille University, CNRS, Assistance publique-Hôpitaux de Marseille (AP-HM), hôpital Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 15, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Castinetti
authors.affiliation: Service de neurochirurgie, hôpital Timone, Assistance publique-Hôpitaux de Marseille (AP-HM), 264, rue Saint-Pierre, 13385 Marseille cedex 15, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Graillon
authors.affiliation: CRN2M-UMR7286, service d'endocrinologie et centre de référence des maladies rares d'origine hypophysaire DEFHY, Aix-Marseille University, CNRS, Assistance publique-Hôpitaux de Marseille (AP-HM), hôpital Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 15, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Brue
authors.affiliation: Service de médecine interne, nutrition et endocrinologie, hôpital de Hautepierre, University Hospital of Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France; Faculty of Medicine, University of Strasbourg, 4, rue Kirschleger, 67000 Strasbourg, France. Electronic address: bernard.goichot@chru-strasbourg.fr.
authors.forename: Bernard
authors.initials: B
authors.lastname: Goichot
mesh_terms: D000293:Adolescent; D000328:Adult; D000077465:Cabergoline; D018491:Dopamine Agonists / Q000627:therapeutic use; D004873:Ergolines / Q000627:therapeutic use*; D005260:Female; D005602:France; D006801:Humans; D006966:Hyperprolactinemia / Q000175:diagnosis / Q000188:drug therapy*; D007018:Hypopituitarism / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000175:diagnosis / Q000188:drug therapy*; D015175:Prolactinoma / Q000175:diagnosis / Q000188:drug therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018491:Dopamine Agonists; D004873:Ergolines; D000077465:Cabergoline
keywords: Agonistes dopaminergiques; Dopamine agonists; Hyperprolactinemia; Hyperprolactinémie; Macroprolactinoma; Macroprolactinome; Outcome; Prolactin; Prolactine; Valvulopathie; Valvulopathy; Évolution