title: Long-term outcome of multimodal therapy for giant prolactinomas.
abstract: Giant prolactinomas are rare tumors characterized by their large size, compressive symptoms, and extremely high prolactin secretion. The aim of this study is to describe our experience with a series of 16 giant prolactinomas cases in terms of clinical presentation, therapeutic decisions, and final outcomes. Retrospective analysis of adult patients diagnosed with giant prolactinomas at the endocrine departments of three university tertiary hospitals. We included 16 patients (43.7 % women); mean age at diagnosis: 42.1 ± 21 years. The most frequent presentation was compressive symptoms. The delay in diagnosis was higher in women (median of 150 months vs. 12 in men; p = 0.09). The mean maximum tumor diameter at diagnosis was 56.9 ± 15.5 mm, and mean prolactin levels were 10,995.9 ± 12,157.8 ng/mL. Dopamine agonists were the first-line treatment in 11 patients (mean maximum dose: 3.9 ± 3.2 mg/week). Surgery was the initial treatment in five patients and the second-line treatment in six. Radiotherapy was used in four cases. All patients but one, are still with dopamine agonists. After a mean follow-up of 9 years, prolactin normalized in 7/16 patients (43.7 %) and 13 patients (81 %) reached prolactin levels lower than twice the upper limit of normal. Mean prolactin level at last visit: 79.5 ± 143 ng/mL. Tumor volume was decreased by 93.8 ± 11.3 %, and final maximum tumor diameter was 18.4 ± 18.8 mm. Three patients are actually tumor free. Giant prolactinomas are characterized by a large tumor volume and extreme prolactin hypersecretion. Multimodal treatment is frequently required to obtain biochemical and tumor control.
authors.affiliation: Endocrinology Division, Complejo Hospitalario Universitario de Ourense (CHUO)-SERGAS, Ourense, 32005, Spain.
authors.forename: Paula
authors.initials: P
authors.lastname: Andujar-Plata
authors.affiliation: Complejo Asistencial Universitario de León (CAULE)-SACYL, León, 24008, Spain.
authors.forename: Rocio
authors.initials: R
authors.lastname: Villar-Taibo
authors.affiliation: Complejo Asistencial Universitario de León (CAULE)-SACYL, León, 24008, Spain.
authors.forename: Maria Dolores
authors.initials: MD
authors.lastname: Ballesteros-Pomar
authors.affiliation: Complejo Asistencial Universitario de León (CAULE)-SACYL, León, 24008, Spain.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Vidal-Casariego
authors.affiliation: Complejo Asistencial Universitario de León (CAULE)-SACYL, León, 24008, Spain.
authors.forename: Begoña
authors.initials: B
authors.lastname: Pérez-Corral
authors.affiliation: Endocrinology Division, Complejo Hospitalario Universitario de Santiago de Compostela (CHUS)-SERGAS, Santiago de Compostela, 15706, Spain.
authors.forename: Jose Manuel
authors.initials: JM
authors.lastname: Cabezas-Agrícola
authors.affiliation: Endocrinology Division, Complejo Hospitalario Universitario de Ourense (CHUO)-SERGAS, Ourense, 32005, Spain.
authors.forename: Paula
authors.initials: P
authors.lastname: Álvarez-Vázquez
authors.affiliation: Neurosurgery Division, Complejo Hospitalario Universitario de Santiago de Compostela (CHUS)-SERGAS, Santiago de Compostela, 15706, Spain.
authors.forename: Ramón
authors.initials: R
authors.lastname: Serramito
authors.affiliation: Endocrinology Division, Complejo Hospitalario Universitario de Santiago de Compostela (CHUS)-SERGAS, Santiago de Compostela, 15706, Spain. ignacio.bernabeu.moron@sergas.es.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Bernabeu
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D018491:Dopamine Agonists / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D010902:Pituitary Gland / Q000601:surgery*; D010911:Pituitary Neoplasms / Q000097:blood / Q000628:therapy*; D011388:Prolactin / Q000097:blood; D015175:Prolactinoma / Q000097:blood / Q000628:therapy*; D011878:Radiotherapy; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018491:Dopamine Agonists; D011388:Prolactin
keywords: Cabergoline; Giant prolactinoma; Pituitary adenoma; Prolactin