| Title | Giant prolactinoma: Efficacy of medical management. | | Author(s) | Acharya SV, Gopal RA, Menon PS, Bandgar TR, Shah NS | | Institution | Dept of Endocrinology, Seth G S Medical College and KEM Hospital, Mumbai 12. | | Source | Endocr Pract 2009 Aug 24.:1-14. | | Abstract | Objective: To review our experience with D2-selective dopamine agonist, for the treatment of giant prolactinomas.
Design: A retrospective study.
Methods: The study group included 10 patients (M: F; 5:5) aged 17-50 years (mean 36.1 years) treated for giant prolactinoma at our center. Cabergoline was started at a dose of 0.5 mg/week and progressively increased as necessary to up to 3.5 mg/week. Two patients were treated with bromocriptine. Patients were followed by hormone measurements, sellar magnetic resonance imaging, and visual examinations.
Results: In eight patients, cabergoline served as first-line therapy. The other two patients had been started on bromocriptine when they presented to us. Mean serum prolactin level before treatment was 10,789 +/- 14278 ng/ml (range: 1256-43163 ng/ml, normal 5-17 ng/ml). Following treatment, levels normalized in seven patients within 2-18 months (mean: 8.8 months) and decreased in one patient to 3-4 times that of normal. Tumor diameter, which measured from 4-7 cm at diagnosis, showed a mean maximal decrease of 49.28 +/- 18.27%; response was first noted about 6 months after the onset of treatment. Seven patients had visual field defects at diagnosis; vision returned to normal in three of them and improved in four. Testosterone levels, initially low in all five patients, normalized in three patients while two others required testosterone replacement.
Conclusion: Cabergoline therapy is the treatment of choice for giant prolactinomas. These findings advocate that cabergoline should be the first-line therapy for aggressive prolactinomas, even in those patients who present with visual field defects. | | Language | ENG | | Pub Type(s) | JOURNAL ARTICLE
| | PubMed ID | 19703803 |
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