Iglesias Pedro, Arcano Karina, Berrocal Víctor Rodríguez, Bernal Carmen, Villabona Carles, Díez Juan José
Department of Endocrinology, Hospital Universitario Ramón y Cajal, Madrid, Spain.
Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain.
Horm Metab Res. 2018 Nov;50(11):791-796. doi: 10.1055/a-0752-0741. Epub 2018 Nov 5.
The aim of the study was to evaluate the clinical features and long-term therapeutic outcome of giant prolactinoma (gPRLoma) in men and to compare them with those of a group of male patients with non-gPRL macroprolactinomas (non-gPRLomas). A retrospective and multicenter study of gPRLomas in men diagnosed in a 20-year period was performed. Clinical data and treatment outcome were registered. The diagnosis of gPRLoma was established when the maximal tumor diameter was ≥40 mm or the tumor had ≥20 mm of suprasellar extension associated to hyperprolactinemia (PRL>1000 ng/ml). Non-gPRLoma was considered when tumor diameter was ≥ 10 mm and<40 mm associated to hyperprolactinemia (PRL≥200 ng/ml). Twenty-three patients with gPRLoma (age 38.3±13.5 years) followed for at least 3 months (follow-up 87.1±60.5 months, range 3-211 months) were evaluated. A group of 42 patients with non-gPRLoma (age 42±16.6 years; NS; follow-up 89±65.9 months, range 3-222 months; NS) served as a control group. More than half (56.5%) of the gPRLoma patients were younger than 40 years at diagnosis. Visual disturbances were significantly more common in gPRLoma than in non-gPRLoma patients (65.2 vs. 25.6%; p=0.004). Prevalence of hypopituitarism was similar in both groups of patients (73.9% vs. 80.9%; gPRLoma vs non-gPRLoma; NS). Serum PRL concentrations were significantly higher in gPRLoma than in non-gPRLoma patients [median (IR), 3978 ng/ml (1179-9012) vs. 907 ng/ml (428-3119); p<0.001]. Maximum tumor diameter in gPRLomas was 4.8±0.8 cm and 2.4±0.7 cm in non-gPRLoma (p<0.001). All patients were treated with dopamine agonists (DA). Twelve (52.2%) gPRLoma patients and 32 (73.8%) non-gPRLoma patients were treated with DA as monotherapy (p=0.045). Surgery was used in 12 (52.2%) gPRLoma patients and in 12 (28.6%) non-gPRLoma patients (p=0.054). Lastly, radiotherapy was used in 5 (21.7%) gPRLoma patients and in 6 (14.2%) non-gPRLoma patients (NS). At last visit, PRL was similar in both groups of patients [16 ng/ml (4-30) vs. 11 ng/ml (4-25); gPRLomas vs. non-gPRLomas; ns] and tumor size decreased significantly (p<0.001) in both groups of patients. Clinical cure (maintained normoprolactinemia without therapy for>1 year and no radiological evidence of pituitary tumor) was achieved in 2 (8.7%) gPRLoma patients and in 2 (4.8%) non-gPRLoma patients (NS). gPRLomas in men are usually diagnosed at a mean age of 40 years, an age similar to that of non-gPRLomas. The only clinical difference with non-gPRLomas is their greater prevalence of visual disturbances. The therapeutic approaches and tumor outcomes were similar to those obtained in patients with non-gPRLomas. Complete cure in gPRLoma is rare, but similar to that achieved in non-gPRLomas, reached in less than 10% of patients.
本研究旨在评估男性巨大泌乳素瘤（gPRLoma）的临床特征和长期治疗效果，并将其与一组非gPRL大泌乳素瘤（非gPRLomas）男性患者进行比较。对20年间诊断出的男性gPRLomas进行了一项回顾性多中心研究。记录了临床数据和治疗结果。当最大肿瘤直径≥40 mm或肿瘤有≥20 mm的鞍上延伸且伴有高泌乳素血症（PRL>1000 ng/ml）时，诊断为gPRLoma。当肿瘤直径≥10 mm且<40 mm并伴有高泌乳素血症（PRL≥200 ng/ml）时，考虑为非gPRLoma。评估了23例gPRLoma患者（年龄38.3±13.5岁），随访至少3个月（随访时间87.1±60.5个月，范围3 - 211个月）。一组42例非gPRLoma患者（年龄42±16.6岁；无显著差异；随访时间89±65.9个月，范围3 - 222个月；无显著差异）作为对照组。超过一半（56.5%）的gPRLoma患者在诊断时年龄小于40岁。gPRLoma患者的视觉障碍明显比非gPRLoma患者更常见（65.2%对25.6%；p = 0.004）。两组患者垂体功能减退的患病率相似（73.9%对80.9%；gPRLoma对非gPRLoma；无显著差异）。gPRLoma患者的血清PRL浓度显著高于非gPRLoma患者[中位数（四分位间距），3978 ng/ml（1179 - 9012）对907 ng/ml（428 - 3119）；p<0.001]。gPRLomas的最大肿瘤直径为4.8±0.8 cm，非gPRLoma为2.4±0.7 cm（p<0.001）。所有患者均接受多巴胺激动剂（DA）治疗。12例（52.2%）gPRLoma患者和32例（73.8%）非gPRLoma患者接受DA单药治疗（p = 0.045）。12例（52.2%）gPRLoma患者和12例（28.6%）非gPRLoma患者接受了手术治疗（p = 0.054）。最后，5例（21.7%）gPRLoma患者和6例（14.2%）非gPRLoma患者接受了放疗（无显著差异）。在最后一次随访时，两组患者的PRL相似[16 ng/ml（4 - 30）对11 ng/ml（4 - 25）；gPRLomas对非gPRLomas；无显著差异]，且两组患者的肿瘤大小均显著减小（p<0.001）。2例（8.7%）gPRLoma患者和2例（4.8%）非gPRLoma患者实现了临床治愈（无需治疗维持正常泌乳素血症>1年且无垂体肿瘤的影像学证据）（无显著差异）。男性gPRLomas通常在平均40岁时被诊断出来，这一年龄与非gPRLomas相似。与非gPRLomas唯一的临床差异在于其视觉障碍的患病率更高。治疗方法和肿瘤结局与非gPRLomas患者相似。gPRLoma的完全治愈很少见，但与非gPRLomas相似，不到10%的患者达到完全治愈。
