Giant prolactinomas, a detailed analysis of 196 adult cases
An erratum to this article was published (Pituitary, 3 Jan 2025 ↗)
Authors' conclusion
Giant prolactinomas are rare and have a male predominance. Visual impairment is the most frequent presenting symptom in men and amenorrhea in women. The gender-related difference in tumor size and level of prolactin was confirmed in this analysis where men had a larger diameter and a higher baseline prolactin level. DAs are the treatment of choice, irrespective of tumor size and presence of visual impairment. As only half of the cases achieved normoprolactinemia we do not, in contrast to previous literature, state giant prolactinomas to be exquisitely sensitive to DAs. Patient characteristics associated with persistent hyperprolactinemia after treatment with a DA were female gender, higher baseline prolactin and larger tumor size . This analysis did show TSH- and ACTH-deficiency to be more frequent after surgery which was not seen for LH/FSH deficiency.
Study context
- Population
- Adults with giant prolactinoma (diameter ≥ 40 mm, prolactin > 1000 ng/ml, no concomitant GH/ACTH secretion); age 38 (28–50) years, F/M ratio 1/3.6
- Participants
- 196 published cases
- Comparison
- Men vs women
- Outcome
- Clinical characteristics and DA outcomes
Methodological detailsstructured literature search, men vs women comparison
- Structured literature search
- Men vs women comparison
Pooled result
As reported in the abstract
- Median tumor diameter
- 53 (43-69) mm
- Pituitary deficiency
- 91%
- First-line dopamine agonist (DA) treatment
- 82%
- Normoprolactinemia with first-line DA
- 51%
- Tumor shrinkage with first-line DA
- 88%
- Visual improvement with first-line DA
- 85%
- Surgery performed
- 29%
Further pooled results
Presenting symptoms by sex
- Visual impairment in men
- 73%
- Headache in men
- 50%
- Amenorrhea in women
- 58%
Women vs men at diagnosis and outcome
- Women had a lower prolactin level and a smaller tumor diameter at diagnosis, but more frequent pituitary deficiencies and worse outcome
Original publication
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