scholarly journals Giant Prolactinomas: An Experience From South India

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A644-A644
Author(s):  
Vishwanath S ◽  
Belinda George ◽  
Vageesh Ayyar ◽  
Ganapathi Bantwal ◽  
Sonali Appaiah
Keyword(s):  
Dopamine Agonist ◽  
Tumor Burden ◽  
Response To Therapy ◽  
Central Hypothyroidism ◽  
Giant Prolactinoma ◽  
Dopamine Agonist Therapy ◽  
Men 2 ◽  
Pituitary Dysfunction ◽  
Median Period ◽  
Giant Prolactinomas

Abstract Giant prolactinomas are large lactotroph adenomas, defined as those with maximum dimension of >4cm. They constitute <5% of all prolactin secreting tumors, and are more frequently seen in men. They present with features of hyperprolactinemia and hypopitutarism and are responsive to dopamine agonist therapies. In the current study we have shared our experience on management of giant prolactinomas over the last 15 years. We collected clinical data retrospectively from medical records of patients with giant prolactinoma managed at our institute over the last 15 years. This study describes the symptomatology, tumor characteristics and response to therapy. Our study included 21 patients with 15 males and 6 females. The mean age of presentation was 32 ± 10.3 years, ranging between 10 to 53 years. Vision defect was the predominant complaint (57%, 12 patients), followed by headache (52%, 11 patients). Erectile dysfunction was a presenting feature in 13% of men (2 patients) and amenorrhea/galactorrhea in 33% of women (2 patients). Seizure was seen in 10% of the patients (2 patients) and 10% (2 patients) were diagnosed with giant prolactinoma on evaluation for primary infertility. Tumor associated pituitary dysfunction manifested as hypogonadism in 67%, 14 patients, central hypothyroidism in 38%, 8 patients, and hypocortisolism in 1 patient. The median maximum tumor dimension was 4.4 cm with median basal PRL of 7168 ng/ml. Five patients underwent debulking surgery (24% of the patients) prior to endocrinology referral for indications such as apoplexy/raised intracranial tension. All patients received cabergoline and a mean dose of 2.1 ± 1.7 mg/week (range, 1-7 mg/week) was prescribed to attain a median nadir prolactin level of 48 ng/ml over a median period of 4 months (range, 1-40 months). The follow-up MRI data was analysed for 13 patients. Tumor shrinkage of >50% from the baseline was seen in all but 1 patient (92%) and 2 patients had disappearance of radiologically detectable tumor. Although giant prolactinomas have a greater tumor burden than the more common macroprolactinomas, the responsiveness to dopamine agonist therapy is excellent and surgical therapy is reserved for any exceedingly large tumors to relieve compression on vital structures.

scholarly journals Reversal of severe cognitive impairment following medical treatment of cystic invasive giant prolactinoma

2016 ◽  
Vol 2016 ◽  
Author(s):  
J Bukowczan ◽  
K Lois ◽  
M Mathiopoulou ◽  
A B Grossman ◽  
R A James
Keyword(s):  
Cognitive Impairment ◽  
Medical Treatment ◽  
Young Patients ◽  
List Type ◽  
Familial Predisposition ◽  
Giant Prolactinoma ◽  
Dopamine Agonist Therapy ◽  
Rare Tumours ◽  
Giant Prolactinomas

Summary Giant prolactinomas are rare tumours of the pituitary, which typically exceed 40 mm in their largest dimension. Impairment of higher cognitive function has been noted post-operatively after transcranial surgery and as a long-term consequence of the radiotherapy treatment. However, there has been little that is reported on such disturbances in relation to the tumour per se, and to our knowledge, there has been none in terms of responsivity to dopamine agonist therapy and shrinkage in these tumours. We present a case of successful restoration of severely impaired cognitive functions achieved safely after significant adenoma involution with medical treatment alone. Learning points Giant prolactinomas can be present with profound cognitive defects. Dopamine agonists remain in the mainstay first-line treatment of giant prolactinomas. Mechanisms of the reversible cognitive impairment associated with giant prolactinoma treatment appear to be complex and remain open to further studies. Young patients with giant prolactinomas mandate genetic testing towards familial predisposition.

scholarly journals Status epilepticus induced by treatment with dopamine agonist therapy for giant prolactinoma: a case report

2019 ◽  
Vol 13 (1) ◽  
Author(s):  
Motofumi Koguchi ◽  
Yukiko Nakahara ◽  
Ryo Ebashi ◽  
Atsushi Ogata ◽  
Shoko Shimokawa ◽  
...  
Keyword(s):  
Case Report ◽  
Status Epilepticus ◽  
Dopamine Agonist ◽  
Agonist Therapy ◽  
Giant Prolactinoma ◽  
Dopamine Agonist Therapy

scholarly journals Management of giant prolactinoma causing craniocervical instability: illustrative case

2021 ◽  
Vol 1 (23) ◽  
Author(s):  
Arunit J. S. Chugh ◽  
Mohit Patel ◽  
Lorayne Chua ◽  
Baha Arafah ◽  
Nicholas C. Bambakidis ◽  
...  
Keyword(s):  
Dopamine Agonist ◽  
Medical Therapy ◽  
Pituitary Tumors ◽  
Symptomatic Improvement ◽  
Serum Prolactin ◽  
Occipital Condyle ◽  
Illustrative Case ◽  
Giant Prolactinoma ◽  
Craniocervical Instability ◽  
Giant Prolactinomas

BACKGROUND Giant prolactinomas (>4 cm) are a rare entity, constituting less than 1% of all pituitary tumors. Diagnosis can usually be achieved through endocrinological analysis, but biopsy may be considered when trying to differentiate between invasive nonfunctioning pituitary adenomas and primary clival tumors such as chordomas. OBSERVATIONS The authors presented a rare case of a giant prolactinoma causing significant clival and occipital condyle erosion, which led to craniocervical instability. They provided a review of the multimodal management. Management involved medical therapy with dopamine agonists, and surgery was reserved for acute neural compression or dopamine agonist resistance, with the caveat that surgery was extremely unlikely to lead to normalization of serum prolactin in dopamine agonist–resistant tumors. LESSONS Adjunctive surgical therapy may be necessary in cases of skull base erosion, particularly when erosion or pathological fractures involve the occipital condyles. Modern posterior occipital-cervical fusion techniques have high rates of arthrodesis and can lead to symptomatic improvement. This procedure should be considered early in the multimodal approach to giant prolactinomas because of the often dramatic response to medical therapy and potential for further craniocervical instability.

Update Treatment for Prolactinoma

2018 ◽  
Vol 3 (06) ◽  
Author(s):  
Chávez Hernández María Margarita ◽  
Jiménez Báez María Valeria ◽  
Armijo Medina María Fernanda ◽  
Domínguez Leyva Jorge Miguel ◽  
Góngora Valencia Karen Alejandra ◽  
...  
Keyword(s):  
Dopamine Agonist ◽  
Safety Profile ◽  
Pituitary Tumor ◽  
Common Type ◽  
Treatment Modalities ◽  
First Line ◽  
Agonist Therapy ◽  
Dopamine Agonist Therapy ◽  
Gonadal Dysfunction

Prolactinomas are the most common type of functional pituitary tumor. The present manuscript is an update on the treatment modalities for prolactinomas. Effective hyperprolactinemia treatment is of great importance, due to its potential deleterious effects including infertility, gonadal dysfunction and osteoporosis. Dopamine agonist therapy is the first line of treatment for prolactinomas; recurrence of disease after cessation of the drug may occur in patients. Its safety profile remains high, allowing its use during pregnancy.

Carbamazepine drug effect simulating biochemical central hypothyroidism in a patient with Bardet-Biedl syndrome

2021 ◽  
Vol 14 (9) ◽  
pp. e245018
Author(s):  
David Kishlyansky ◽  
Gregory Kline
Keyword(s):  
Replacement Therapy ◽  
Clinical Significance ◽  
Anterior Pituitary ◽  
Reference Range ◽  
Drug Effect ◽  
Free T4 ◽  
Central Hypothyroidism ◽  
Bardet Biedl Syndrome ◽  
Pituitary Dysfunction

Carbamazepine (CBZ) is a medication used commonly in epilepsy. Decreases in free T4 levels simulating central hypothyroidism have been reported, although the clinical significance is still unclear. We present a 24-year-old man with Bardet-Biedl syndrome (BBS) who was found to have isolated biochemical central hypothyroidism. BBS is a ciliopathy occasionally associated with anterior pituitary dysfunction. While taking CBZ for epilepsy, his TSH was 1.73 mIU/L (reference range: 0.20–4.00 mIU/L) with a low free T4 of 6.6 pmol/L (reference range: 10.0–26.0 pmol/L). Pituitary MRI was normal. Although treated with levothyroxine initially, his apparent biochemical central hypothyroidism was later recognised as secondary to CBZ drug effect. This was confirmed with a normal free T4 of 12.2 pmol/L while he was off CBZ and levothyroxine. Despite the association between CBZ and biochemical central hypothyroidism, nearly all patients remain clinically euthyroid. This effect is reversible and recognition could lead to reductions in unnecessary thyroid replacement therapy if CBZ is discontinued.

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