Department of Molecular Medicine and Surgery, Karolinska Institute, 171 76, Stockholm, Sweden.
Department of Internal Medicine, Center for Endocrinology and Diabetes, Karlstad Central Hospital, 651 85, Karlstad, Sweden.
J Clin Endocrinol Metab. 2023 Nov 17;108(12):e1506-e1514. doi: 10.1210/clinem/dgad393.
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.
描述全国性大型泌乳素瘤患者队列的临床表现和治疗结果。
在瑞典垂体登记处 1991 年至 2018 年间，对血清泌乳素（PRL）>1000μg/L、肿瘤直径≥40mm 的大型泌乳素瘤患者进行了一项基于登记的研究。
本研究共纳入 84 例患者[平均年龄 47（SD±16）岁，89%为男性]。诊断时，中位 PRL 为 6305μg/L（范围 1450-253000），肿瘤直径中位数为 47mm（范围 40-85），84%的患者存在促性腺激素低下性性腺功能减退症，71%存在视野缺损。所有患者均在某个阶段接受了多巴胺激动剂（DA）治疗。23 例（27%）患者接受了 1 种或多种额外治疗，包括手术（n=19）、放疗（n=6）、其他药物治疗（n=4）和化疗（n=2）。Ki-67 指数≥10%的有 4/14 例肿瘤。在末次随访时[中位数 9 年（四分位距（IQR）4-15）]，中位 PRL 为 12μg/L（IQR 4-126），肿瘤直径中位数为 22mm（IQR 3-40）。55%患者的 PRL 恢复正常，69%患者的肿瘤显著缩小，43%患者联合缓解（PRL 正常化和肿瘤显著缩小）。在接受初始 DA 治疗的患者（n=79）中，第 1 年时 PRL 或肿瘤大小的降低可预测末次随访时的联合缓解（P<0.001 和 P=0.012）。
DA 有效降低了 PRL 和肿瘤大小，但约每 4 例患者中就有 1 例需要多模式治疗。我们的研究结果表明，DA 治疗 1 年后的反应有助于识别需要更密切监测的患者，在某些情况下，需要额外的治疗。
