Giant prolactinomas in women

TY - JOUR

T1 - Giant prolactinomas in women

AU - Delgrange, Etienne

AU - Raverot, Gerald

AU - Bex, Marie

AU - Burman, Pia

AU - Decoudier, Bénédicte

AU - Devuyst, France

AU - Feldt-Rasmussen, Ulla

AU - Andersen, Marianne

AU - Maiter, Dominique

PY - 2014/1

Y1 - 2014/1

N2 - Objective: To characterise distinctive clinical features of giant prolactinomas in women. Design: A multicentre, retrospective case series and literature review. Methods: We collected data from 15 female patients with a pituitary tumour larger than 4 cm and prolactin levels above 1000 mg/l and identified 19 similar cases from the literature; a gender-based comparison of the frequency and age distribution was obtained from a literature review. Results: The initial PubMed search using the term 'giant prolactinomas' identified 125 patients (13 women) responding to the inclusion criteria. The female:male ratio was 1:9. Another six female patients were found by extending the literature search, while our own series added 15 patients. The median age at diagnosis was 44 years in women compared with 35 years in men (P<0.05). All cases diagnosed before the age of 15 years were boys. In women (n=34), we observed a minor peak incidence during the third decade of life and a major peak during the fifth decade. Amenorrhoea was a constant feature with seven cases of primary amenorrhoea. In eight women with onset of secondary amenorrhoea before the age of 40 years, the diagnosis was made 2-31 years later (median 9 years) and in all but one because of tumour pressure symptoms. The prolactin levels were above 10 000 μg/l in 15/34 and misdiagnosis due to 'hook effect' occurred in two of them. Eighteen patients were treated with cabergoline; standard doses (<2.0 mg/week) were able to normalise prolactin in only 4/18 patients, and 7/18 patients were resistant to weekly doses ranging from 3.0 to 7.0 mg. Conclusion: Giant prolactinomas are rare in women, often resistant to dopamine agonists and seem to be distributed in two age groups, with a larger late-onset peak.

AB - Objective: To characterise distinctive clinical features of giant prolactinomas in women. Design: A multicentre, retrospective case series and literature review. Methods: We collected data from 15 female patients with a pituitary tumour larger than 4 cm and prolactin levels above 1000 mg/l and identified 19 similar cases from the literature; a gender-based comparison of the frequency and age distribution was obtained from a literature review. Results: The initial PubMed search using the term 'giant prolactinomas' identified 125 patients (13 women) responding to the inclusion criteria. The female:male ratio was 1:9. Another six female patients were found by extending the literature search, while our own series added 15 patients. The median age at diagnosis was 44 years in women compared with 35 years in men (P<0.05). All cases diagnosed before the age of 15 years were boys. In women (n=34), we observed a minor peak incidence during the third decade of life and a major peak during the fifth decade. Amenorrhoea was a constant feature with seven cases of primary amenorrhoea. In eight women with onset of secondary amenorrhoea before the age of 40 years, the diagnosis was made 2-31 years later (median 9 years) and in all but one because of tumour pressure symptoms. The prolactin levels were above 10 000 μg/l in 15/34 and misdiagnosis due to 'hook effect' occurred in two of them. Eighteen patients were treated with cabergoline; standard doses (<2.0 mg/week) were able to normalise prolactin in only 4/18 patients, and 7/18 patients were resistant to weekly doses ranging from 3.0 to 7.0 mg. Conclusion: Giant prolactinomas are rare in women, often resistant to dopamine agonists and seem to be distributed in two age groups, with a larger late-onset peak.

KW - Adolescent

KW - Adult

KW - Age of Onset

KW - Aged

KW - Aged, 80 and over

KW - Amenorrhea

KW - Antineoplastic Agents

KW - Dopamine Agonists

KW - Drug Resistance, Neoplasm

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Hyperprolactinemia

KW - Middle Aged

KW - Pituitary Gland

KW - Pituitary Neoplasms

KW - Prolactin

KW - Prolactinoma

KW - Tumor Burden

KW - Young Adult

U2 - 10.1530/eje-13-0503

DO - 10.1530/eje-13-0503

M3 - Journal article

C2 - 24088550

SN - 0804-4643

VL - 170

SP - 31

EP - 38

JO - European Journal of Endocrinology

JF - European Journal of Endocrinology

IS - 1

ER -