Format

Send to

Choose Destination
Ann Endocrinol (Paris). 2016 Dec;77(6):641-648. doi: 10.1016/j.ando.2016.07.004. Epub 2016 Sep 15.

Long-term outcome of macroprolactinomas.

Author information

1
Service de médecine interne, nutrition et endocrinologie, hôpital de Hautepierre, University Hospital of Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France.
2
Service de neurochirurgie, hôpital de Hautepierre, University Hospital of Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France.
3
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.
4
Service de neurochirurgie, hôpital Timone, Assistance publique-Hôpitaux de Marseille (AP-HM), 264, rue Saint-Pierre, 13385 Marseille cedex 15, France.
5
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.

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.

PATIENTS AND 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.

KEYWORDS:

Agonistes dopaminergiques; Dopamine agonists; Hyperprolactinemia; Hyperprolactinémie; Macroprolactinoma; Macroprolactinome; Outcome; Prolactin; Prolactine; Valvulopathie; Valvulopathy; Évolution

PMID:
27641080
DOI:
10.1016/j.ando.2016.07.004
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center