Long-term Follow-up of 84 Patients With Giant Prolactinomas-A Swedish Nationwide Study.

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Long-term Follow-up of 84 Patients With Giant Prolactinomas-A Swedish Nationwide Study.

Himonakos, Christos (author): Karolinska Institute,Karlstad Hospital,Karolinska Inst, Dept Mol Med & Surg, S-17176 Stockholm, Sweden.;Karlstad Cent Hosp, Ctr Endocrinol & Diabet, Dept Internal Med, S-65185 Karlstad, Sweden.;Karlstad Cent Hosp, Ctr Endocrinol & Diabet, Dept Internal Med, Rosenborgsgatan 9, S-65185 Karlstad, Sweden.

Burman, Pia (author): Lund University,Lunds universitet,Translationell muskelforskning,Forskargrupper vid Lunds universitet,Translational Muscle Research,Lund University Research Groups,Skåne University Hospital,Lund Univ, Skane Univ Hosp, Dept Endocrinol, S-21428 Malmö, Sweden.

Borg, Henrik (author): Lund University,Lunds universitet,Medicin/akutsjukvård, Lund,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Medicine, Lund,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Skåne University Hospital,Lund Univ, Skane Univ Hosp, Dept Endocrinol, S-22242 Lund, Sweden.

Dahlqvist, Per (author): Umeå University,Umeå universitet,Institutionen för folkhälsa och klinisk medicin,Umeå Univ, Dept Publ Hlth & Clin Med, S-90187 Umeå, Sweden.

Edén Engström, Britt (author): Uppsala universitet,Endokrinologi och mineralmetabolism,Uppsala University Hospital, Uppsala, Sweden

Ekman, Bertil (author): Linköping University,Linköpings universitet,Avdelningen för diagnostik och specialistmedicin,Medicinska fakulteten,Region Östergötland, Endokrinmedicinska kliniken,Linköping Univ, Dept Endocrinol, S-58183 Linköping, Sweden.;Linköping Univ, Dept Hlth Med & Caring Sci, S-58183 Linköping, Sweden.

Emilsson, Louise (author): Karolinska Institutet,Karolinska Institute,University of Oslo,Univ Oslo, Inst Hlth & Soc, Dept Gen Practice, N-0318 Oslo, Norway.;Cty Council Varmland, Nysater Hlth Care Ctr, S-65185 Karlstad, Sweden.;Cty Council Varmland, Ctr Clin Res, S-65185 Karlstad, Sweden.;Karolinska Inst, Dept Med Epidemiol & Biostat, S-17177 Stockholm, Sweden.

Olsson, Daniel S, 1983 (author): Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för invärtesmedicin och klinisk nutrition,Institute of Medicine, Department of Internal Medicine and Clinical Nutrition,Department of Endocrinology at Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Internal Medicine and Clinical Nutrition, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden,Sahlgrens Univ Hosp, Dept Endocrinol, S-41345 Gothenburg, Sweden.;Univ Gothenburg, Sahlgrenska Acad, Inst Med, Dept Internal Med & Clin Nutr, S-41345 Gothenburg, Sweden.;AstraZeneca, BioPharmaceut R&D, Cardiovasc Renal & Metab, S-43051 Gothenburg, Sweden.

Ragnarsson, Oskar, 1971 (author): Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för invärtesmedicin och klinisk nutrition,Institute of Medicine, Department of Internal Medicine and Clinical Nutrition,Department of Endocrinology at Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Internal Medicine and Clinical Nutrition, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,Sahlgrens Univ Hosp, Dept Endocrinol, S-41345 Gothenburg, Sweden.;Univ Gothenburg, Sahlgrenska Acad, Inst Med, Dept Internal Med & Clin Nutr, S-41345 Gothenburg, Sweden.

Wahlberg, Jeanette, 1969- (author): Örebro University,Örebro universitet,Institutionen för medicinska vetenskaper,Department of Medicine, Örebro University Hospital, Sweden; School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Sweden,Örebro Univ Hosp, Dept Med, S-70185 Örebro, Sweden.;Örebro Univ, Fac Med & Hlth, Sch Med Sci, S-70182 Örebro, Sweden.

Åkerman, Anna-Karin (author): Karolinska Institutet,Karolinska Institute,Örebro University Hospital,Karolinska Inst, Dept Mol Med & Surg, S-17176 Stockholm, Sweden.;Örebro Univ Hosp, Dept Med, S-70185 Örebro, Sweden.

Höybye, Charlotte (author): Karolinska Institutet,Karolinska Institute,Karolinska University Hospital,Karolinska Inst, Dept Mol Med & Surg, S-17176 Stockholm, Sweden.;Karolinska Univ Hosp, Dept Endocrinol, S-17176 Stockholm, Sweden.

Berinder, Katarina (author): Karolinska Institutet,Karolinska Institute,Karolinska University Hospital,Karolinska Inst, Dept Mol Med & Surg, S-17176 Stockholm, Sweden.

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Oxford University Press, 2023
2023
English.
In: The Journal of clinical endocrinology and metabolism. - : Oxford University Press. - 1945-7197 .- 0021-972X. ; 108:12

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Journal article (peer-reviewed)

Abstract Subject headings

To describe the clinical presentation and treatment outcomes in a nationwide cohort of patients with giant prolactinomas.Register-based study of patients with giant prolactinomas [serum prolactin (PRL) > 1000 µg/L, tumor diameter ≥40 mm] identified in the Swedish Pituitary Register 1991-2018.Eighty-four patients [mean age 47 (SD ±16) years, 89% men] were included in the study. At diagnosis, the median PRL was 6305 µg/L (range 1450-253 000), the median tumor diameter was 47 mm (range 40-85), 84% of the patients had hypogonadotropic hypogonadism, and 71% visual field defects. All patients were treated with a dopamine agonist (DA) at some point. Twenty-three (27%) received 1 or more additional therapies, including surgery (n = 19), radiotherapy (n = 6), other medical treatments (n = 4), and chemotherapy (n = 2). Ki-67 was ≥10% in 4/14 tumors. At the last follow-up [median 9 years (interquartile range (IQR) 4-15)], the median PRL was 12 µg/L (IQR 4-126), and the median tumor diameter was 22 mm (IQR 3-40). Normalized PRL was achieved in 55%, significant tumor reduction in 69%, and combined response (normalized PRL and significant tumor reduction) in 43%. In the primary DA-treated patients (n = 79), the reduction in PRL or tumor size after the first year predicted the combined response at the last follow-up (P < .001 and P = .012, respectively).DAs effectively reduced PRL and tumor size, but approximately 1 patient out of 4 needed multimodal treatment. Our results suggest that the response to DA after 1 year is useful for identifying patients who need more careful monitoring and, in some cases, additional treatment.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Endokrinologi och diabetes (hsv//swe)
MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Endocrinology and Diabetes (hsv//eng)
MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kirurgi (hsv//swe)
MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Surgery (hsv//eng)

Keyword

Male
Humans
Middle Aged
Female
Prolactinoma
drug therapy
pathology
Pituitary Neoplasms
therapy
drug therapy
Follow-Up Studies
Sweden
epidemiology
Prolactin
Dopamine Agonists
therapeutic use
giant prolactinomas
dopamine agonist resistance
dopamine agonists
giant prolactinomas
Ki-67
long-term follow-up

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