Evaluation of Medical Treatment Results in Patients with Giant Prolactinoma Who Previously Underwent Surgery or Not

Yıl 2024, Cilt: 50 Sayı: 3, 543 - 549, 12.01.2025

Filiz Mercan Sarıdaş , Erhan Hocaoğlu , Müge Yaşar , Kadircan Karatoprak , Özen Öz Gül , Soner Cander

https://doi.org/10.32708/uutfd.1538430

Öz

In this single-center retrospective study, we aimed to evaluate the results of medical therapy as primary or secondary treatment following surgery and compare follow-up outcomes between the two approaches. Patients were grouped as medical therapy alone (Group M) and surgery plus medical therapy (Group S+M). Patients' demographics, such as age and gender, and age at the diagnosis were recorded. Differences between the pre-and post-treatment tumor size, prolactin (PRL) levels, Knosp grades, tumor response to treatment, improvement in hypofunctions, visual field, and biochemical control were recorded and compared between the two groups. A total of 41 patients diagnosed with giant prolactinomas were included in the study. Hypopituitarism was found in 82.93%, hypogonadism in 80.59%, GH deficiency in 51.22%, ACTH deficiency in 36.59%, and TSH deficiency in 41.46% of the patients. Visual field defects were found by 60.53%. Tumor volume at diagnosis was significantly higher in Group M (p<0.001). A mean tumor volume reduction of 75.22% was observed with medical therapy alone, compared to 60.20% achieved with surgical intervention and medical therapy (p=0.36). The comparison of PRL levels at the last visit revealed no statistically significant difference between the groups (p > 0.05). This study's results demonstrate no statistically significant difference between medical therapy alone and surgery plus medical therapy regarding the reduction of tumor volume and normalization of PRL values in patients with giant prolactinomas. Surgery should be reserved for severe compression conditions, and potentially unnecessary surgical approaches should be avoided.

Anahtar Kelimeler

giant prolactinoma, medical treatment, decompression, tumor volume, prolactin

Operasyon Öyküsü Olan ve Olmayan Dev Prolaktinomalı Hastalarda Medikal Tedavi Sonuçlarının Değerlendirilmesi

Öz

Bu tek merkezli retrospektif çalışmada, primer tedavi veya cerrahi sonrası sekonder tedavi olarak medikal tedavinin sonuçlarını değerlendirmeyi ve iki yaklaşım arasındaki takip sonuçlarını karşılaştırmayı amaçladık. Hastalar tek başına medikal tedavi (Grup M) ve cerrahi + medikal tedavi (Grup S+M) olarak gruplandırıldı. Hastaların yaş ve cinsiyet gibi demografik özellikleri ve tanı anındaki yaşları kaydedildi. Tedavi öncesi ve sonrası tümör boyutu, prolaktin (PRL) düzeyleri, Knosp dereceleri, tedaviye tümör yanıtı, hipofonksiyonlarda iyileşme, görme alanı ve biyokimyasal kontrol arasındaki farklar kaydedildi ve iki grup arasında karşılaştırıldı.Çalışmaya dev prolaktinoma tanısı konulan toplam 41 hasta dahil edildi. Hastaların %82.93'ünde hipopituitarizm, %80.59'unda hipogonadizm, %51.22'sinde GH eksikliği, %36.59'unda ACTH eksikliği ve %41.46'sında TSH eksikliği saptandı. Görme alanı defekti %60.53 oranında saptanmıştır. Tanı anındaki tümör hacmi Grup M'de anlamlı olarak daha yüksekti (p<0.001). Tümör hacmindeki ortalama azalma sadece medikal tedavi ile %75.22 ve cerrahi+medikal tedavi ile %60.20 idi (p=0.36). Son vizitte PRL düzeyleri açısından gruplar arasında istatistiksel olarak anlamlı bir fark bulunmadı (p>0.05). Bu çalışmanın sonuçları, dev prolaktinomalı hastalarda tümör hacminin küçülmesi ve PRL değerlerinin normalleşmesi açısından tek başına medikal tedavi ile cerrahi+medikal tedavi arasında anlamlı bir fark olmadığını göstermektedir. Cerrahi, ciddi bası durumları için saklanmalı ve potansiyel olarak gereksiz cerrahi yaklaşımlardan kaçınılmalıdır.

Anahtar Kelimeler

dev prolaktinoma, medikal tedavi, dekompresyon, tümör hacmi, prolaktin

Kaynakça

• 1. Remon-Ruiz P, Venegas-Moreno E, Dios Fuentes E, Matias Kaen A, Cardenas Ruiz-Valdepenas E, Martin-Schrader I, et al. Our experience in prolactinomas larger than 60mm. Endocrinol Diabetes Nutr (Engl Ed). 2021;68(1):3-10.
• 2. Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, Burger PC,Jouvet A, et al. The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol. 2007;114(2):97-109.
• 3. Smith TR, Hulou MM, Huang KT, Gokoglu A, Cote DJ, Woodmansee WW, et al. Current indications for the surgical treatment of prolactinomas. J Clin Neurosci. 2015;22(11):1785-91.
• 4. Maiter D, Delgrange E. Therapy of endocrine disease: the challenges in managing giant prolactinomas. Eur J Endocrinol. 2014;170(6):R213-27.
• 5. Shimon I, Sosa E, Mendoza V, Greenman Y, Tirosh A,Espinosa E, et al. Giant prolactinomas larger than 60 mm insize: a cohort of massive and aggressive prolactin-secreting pituitary adenomas. Pituitary. 2016;19(4):429-36.
• 6. Acharya SV, Gopal RA, Menon PS, Bandgar TR, Shah NS. Giant prolactinoma and effectiveness of medical management. Endocr Pract. 2010;16(1):42-6.
• 7. Shimon I. Giant Prolactinomas. Neuroendocrinology.2019;109(1):51-6.
• 8. Alsubaie S, Almalki MH. Cabergoline treatment in invasive giant prolactinoma. Clin Med Insights Case Rep. 2014;7:49-51.
• 9. Gillam MP, Molitch ME, Lombardi G, Colao A. Advances in the treatment of prolactinomas. Endocr Rev. 2006;27(5):485-534.
• 10. Lin S, Zhang A, Zhang X, Wu ZB. Treatment of Pituitary andOther Tumours with Cabergoline: New Mechanisms andPotential Broader Applications. Neuroendocrinology.2020;110(6):477-88.
• 11. Molitch ME. Management of medically refractory prolactinoma. J Neurooncol. 2014;117(3):421-8.
• 12. Moraes AB, Silva CM, Vieira Neto L, Gadelha MR. Giant prolactinomas: the therapeutic approach. Clin Endocrinol (Oxf).2013;79(4):447-56.
• 13. Cander S, Oz Gul O, Eylemer E, Gullulu Boz E, Gunes E,Hakyemez B, et al. Comparison of the effects of medical and surgical treatments in giant prolactinoma: a single-center experience. Hormones (Athens). 2021;20(3):491-8.
• 14. Di Chiro G, Nelson KB. The volume of the sella turcica. Am JRoentgenol Radium Ther Nucl Med. 1962;87:989-1008.
• 15. Cander S, Karkucak M, Gul OO, Sag SO, Yakut T, Ersoy C, etal. Association between p16(CDKN2A) C540G polymorphism and tumor behavior in prolactinoma: A single-center study.Biomed Rep. 2014;2(4):589-95.
• 16. Corsello SM, Ubertini G, Altomare M, Lovicu RM, Migneco MG, Rota CA, et al. Giant prolactinomas in men: efficacy ofcabergoline treatment. Clin Endocrinol (Oxf). 2003;58(5):662-70.
• 17. Micko AS, Wohrer A, Wolfsberger S, Knosp E. Invasion of thecavernous sinus space in pituitary adenomas: endoscopic verification and its correlation with an MRI-basedclassification. J Neurosurg. 2015;122(4):803-11.
• 18. Cander S, Erturk E, Karkucak M, Oz Gul O, Gorukmez O,Yakut T, et al. Effect of cyclin [corrected] D1 (CCND1) gene polymorphism on tumor formation and behavior in patients with prolactinoma. Gene. 2012;509(1):158-63.
• 19. Lundholm MD, Yogi-Morren D, Pantalone KM, Recinos PF,Kshettry VR, Rao PPR. Surgical Management of Giant Prolactinomas: A Descriptive Study. Int J Endocrinol. 2023;2023:1990259.
• 20. Melmed S. The Pituitary. London, England: Academic Press;2017: 465-501.
• 21. Chentli F, Azzoug S, Daffeur K, Akkache L, Zellagui H,Haddad M, et al. Neurological, psychiatric, ophthalmological, and endocrine complications in giant male prolactinomas: An observational study in Algerian population. Indian J Endocrinol Metab. 2015;19(3):359-63.
• 22. Almalki MH, Aljohani N, Alzahrani S, Almohareb O, Ahmad MM, Alrashed AA, et al. Clinical Features, Therapeutic Trends, and Outcome of Giant Prolactinomas: A Single-Center Experience Over a 12-Year Period. Clin Med Insights Endocrinol Diabetes. 2020;13:1179551420926181.
• 23. Iglesias P, Arcano K, Berrocal VR, Bernal C, Villabona C, Diez JJ. Giant Prolactinoma in Men: Clinical Features and Therapeutic Outcomes. Horm Metab Res. 2018;50(11):791-6.
• 24. Shimon I, Benbassat C, Hadani M. Effectiveness of long-term cabergoline treatment for giant prolactinoma: study of 12 men. Eur J Endocrinol. 2007;156(2):225-31.
• 25. Lisa B, Arno V, Christophe B, Heyning Paul V, Carlien H.Giant prolactinomas, a detailed analysis of 196 adult cases. Pituitary. 2023;26(5):529-37.
• 26. Lv L, Hu Y, Yin S, Zhou P, Yang Y, Ma W, et al. GiantProlactinomas: Outcomes of Multimodal Treatments for 42 Cases with Long-Term Follow-Up. Exp Clin Endocrinol Diabetes. 2019;127(5):295-302.
• 27. Kumar S, Memon SS, Lila AR, Sarathi V, Sehemby M, Karlekar M, et al. Giant prolactinoma in Asian-Indians: Asingle-center experience from Western India. Ann Endocrinol (Paris). 2023;84(6):711-8.
• 28. Himonakos C, Burman P, Borg H, Dahlqvist P, Engstrom BE, Ekman B, et al. Long-term Follow-up of 84 Patients With Giant Prolactinomas-A Swedish Nationwide Study. J Clin Endocrinol Metab. 2023;108(12):e1506-e14.
• 29. Espinosa E, Sosa E, Mendoza V, Ramirez C, Melgar V, Mercado M. Giant prolactinomas: are they really different fromordinary macroprolactinomas? Endocrine. 2016;52(3):652-9.