Skip to main content
Top
Published in: Pituitary 2/2014

01-04-2014

Is a stable or decreasing prolactin level in a patient with prolactinoma a surrogate marker for lack of tumor growth?

Authors: Abdulrahman G. Alkabbani, Sann Y. Mon, Betul Hatipoglu, Laurence Kennedy, Charles Faiman, Robert J. Weil, Amir H. Hamrahian

Published in: Pituitary | Issue 2/2014

Login to get access

Abstract

The optimal interval for follow-up imaging of patients with prolactinomas is unclear. We wish to determine the likelihood of tumor enlargement in patients with prolactinomas who have a stable or reduced prolactin (PRL) level over time, whether or not they are treated with a dopamine agonist (DA). We identified 80 patients with prolactinomas (34 men, 46 women) who had at least two paired sets of serum PRL levels and pituitary MRIs, 3 or more months apart. Patients with hyperprolactinemia due to drug or stalk effects were excluded. The median (range) age was 45 (25–77) years. Sixty-three patients (78.8 %) were treated with DA. PRL levels (ng/mL) at the initial and latest sets were 114 (0.3–15,732) and 16 (0.3–1,204), respectively. In patients with identifiable tumors, the maximum tumor diameters (mm) at the initial and latest MRI studies were 12.5 (2–60) and 12.5 (2–39) respectively, with an interval of 2.9 (0.3–9.7) years. Sixty percent of patients (n = 48) had a macroadenoma. Forty-two (52.5 %) patients had either disappearance of the tumor (n = 22) or reduction (n = 20) in tumor size. In the remainder, tumor size was stable in 35 but increased in 3 patients. One of these patients, observed off therapy had a concomitant rise in PRL level. The other 2 had evidence of pituitary hemorrhage with no PRL increase. Tumor growth in prolactinoma patients with a stable or decreasing PRL level, regardless of size, is a rare event. Repetitive pituitary imaging in these patients may not be warranted.
Literature
1.
go back to reference Kars M, Dekkers OM, Pereira AM, Romijn JA (2010) Update in prolactinomas. Neth J Med 68:104–112PubMed Kars M, Dekkers OM, Pereira AM, Romijn JA (2010) Update in prolactinomas. Neth J Med 68:104–112PubMed
2.
go back to reference Mancini T, Casanueva FF, Giustina A (2008) Hyperprolactinemia and prolactinomas. Endocrinol Metab Clin North Am 37:67–99 (viii)PubMedCrossRef Mancini T, Casanueva FF, Giustina A (2008) Hyperprolactinemia and prolactinomas. Endocrinol Metab Clin North Am 37:67–99 (viii)PubMedCrossRef
3.
go back to reference Melmed S, Casanueva FF, Hoffman AR, Kleinberg DL, Montori VM, Schlechte JA, Wass JA, Endocrine Society (2011) Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 96:273–288PubMedCrossRef Melmed S, Casanueva FF, Hoffman AR, Kleinberg DL, Montori VM, Schlechte JA, Wass JA, Endocrine Society (2011) Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 96:273–288PubMedCrossRef
4.
go back to reference Colao A, Di Sarno A, Landi ML, Cirillo S, Sarnacchiaro F, Facciolli G, Pivonello R, Cataldi M, Merola B, Annunziato L, Lombardi G (1997) Long-term and low-dose treatment with cabergoline induces macroprolactinoma shrinkage. J Clin Endocrinol Metab 82:3574–3579PubMedCrossRef Colao A, Di Sarno A, Landi ML, Cirillo S, Sarnacchiaro F, Facciolli G, Pivonello R, Cataldi M, Merola B, Annunziato L, Lombardi G (1997) Long-term and low-dose treatment with cabergoline induces macroprolactinoma shrinkage. J Clin Endocrinol Metab 82:3574–3579PubMedCrossRef
5.
go back to reference Casanueva FF, Molitch ME, Schlechte JA, Abs R, Bonert V, Bronstein MD, Brue T, Cappabianca P, Colao A, Fahlbusch R, Fideleff H, Hadani M, Kelly P, Kleinberg D, Laws E, Marek J, Scanlon M, Sobrinho LG, Wass JA, Giustina A (2006) Guidelines of the pituitary society for the diagnosis and management of prolactinomas. Clin Endocrinol (Oxf) 65:265–273CrossRef Casanueva FF, Molitch ME, Schlechte JA, Abs R, Bonert V, Bronstein MD, Brue T, Cappabianca P, Colao A, Fahlbusch R, Fideleff H, Hadani M, Kelly P, Kleinberg D, Laws E, Marek J, Scanlon M, Sobrinho LG, Wass JA, Giustina A (2006) Guidelines of the pituitary society for the diagnosis and management of prolactinomas. Clin Endocrinol (Oxf) 65:265–273CrossRef
7.
go back to reference Biller BM, Luciano A, Crosignani PG, Molitch M, Olive D, Rebar R, Sanfilippo J, Webster J, Zacur H (1999) Guidelines for the diagnosis and treatment of hyperprolactinemia. J Reprod Med 44:1075–1084PubMed Biller BM, Luciano A, Crosignani PG, Molitch M, Olive D, Rebar R, Sanfilippo J, Webster J, Zacur H (1999) Guidelines for the diagnosis and treatment of hyperprolactinemia. J Reprod Med 44:1075–1084PubMed
8.
10.
go back to reference Randall BR, Kraus KL, Simard MF, Couldwell WT (2010) Cost of evaluation of patients with pituitary incidentaloma. Pituitary 13:383–384PubMedCrossRef Randall BR, Kraus KL, Simard MF, Couldwell WT (2010) Cost of evaluation of patients with pituitary incidentaloma. Pituitary 13:383–384PubMedCrossRef
11.
go back to reference Schlechte J, Dolan K, Sherman B, Chapler F, Luciano A (1989) The natural history of untreated hyperprolactinemia: a prospective analysis. J Clin Endocrinol Metab 68:412–418PubMedCrossRef Schlechte J, Dolan K, Sherman B, Chapler F, Luciano A (1989) The natural history of untreated hyperprolactinemia: a prospective analysis. J Clin Endocrinol Metab 68:412–418PubMedCrossRef
12.
go back to reference March CM, Kletzky OA, Davajan V, Teal J, Weiss M, Apuzzo ML, Marrs RP, Mishell DR Jr (1981) Longitudinal evaluation of patients with untreated prolactin-secreting pituitary adenomas. Am J Obstet Gynecol 139:835–844PubMed March CM, Kletzky OA, Davajan V, Teal J, Weiss M, Apuzzo ML, Marrs RP, Mishell DR Jr (1981) Longitudinal evaluation of patients with untreated prolactin-secreting pituitary adenomas. Am J Obstet Gynecol 139:835–844PubMed
13.
go back to reference Webster J, Piscitelli G, Polli A, Ferrari CI, Ismail I, Scanlon MF (1994) A comparison of cabergoline and bromocriptine in the treatment of hyperprolactinemic amenorrhea. Cabergoline comparative study group. N Engl J Med 331:904–909PubMedCrossRef Webster J, Piscitelli G, Polli A, Ferrari CI, Ismail I, Scanlon MF (1994) A comparison of cabergoline and bromocriptine in the treatment of hyperprolactinemic amenorrhea. Cabergoline comparative study group. N Engl J Med 331:904–909PubMedCrossRef
14.
go back to reference Colao A, Di Sarno A, Landi ML, Scavuzzo F, Cappabianca P, Pivonello R, Volpe R, Di Salle F, Cirillo S, Annunziato L, Lombardi G (2000) Macroprolactinoma shrinkage during cabergoline treatment is greater in naive patients than in patients pretreated with other dopamine agonists: a prospective study in 110 patients. J Clin Endocrinol Metab 85:2247–2252PubMed Colao A, Di Sarno A, Landi ML, Scavuzzo F, Cappabianca P, Pivonello R, Volpe R, Di Salle F, Cirillo S, Annunziato L, Lombardi G (2000) Macroprolactinoma shrinkage during cabergoline treatment is greater in naive patients than in patients pretreated with other dopamine agonists: a prospective study in 110 patients. J Clin Endocrinol Metab 85:2247–2252PubMed
15.
16.
go back to reference Breidahl HD, Topliss DJ, Pike JW (1983) Failure of bromocriptine to maintain reduction in size of a macroprolactinoma. Br Med J (Clin Res Ed) 287:451–452CrossRef Breidahl HD, Topliss DJ, Pike JW (1983) Failure of bromocriptine to maintain reduction in size of a macroprolactinoma. Br Med J (Clin Res Ed) 287:451–452CrossRef
17.
go back to reference Morange I, Barlier A, Pellegrini I, Brue T, Enjalbert A, Jaquet P (1996) Prolactinomas resistant to bromocriptine: long-term efficacy of quinagolide and outcome of pregnancy. Eur J Endocrinol 135:413–420PubMedCrossRef Morange I, Barlier A, Pellegrini I, Brue T, Enjalbert A, Jaquet P (1996) Prolactinomas resistant to bromocriptine: long-term efficacy of quinagolide and outcome of pregnancy. Eur J Endocrinol 135:413–420PubMedCrossRef
18.
go back to reference Delgrange E, Crabbe J, Donckier J (1998) Late development of resistance to bromocriptine in a patient with macroprolactinoma. Horm Res 49:250–253PubMedCrossRef Delgrange E, Crabbe J, Donckier J (1998) Late development of resistance to bromocriptine in a patient with macroprolactinoma. Horm Res 49:250–253PubMedCrossRef
19.
go back to reference Scotti G, Scialfa G, Pieralli S, Chiodini PG, Spelta B, Dallabonzana D (1982) Macroprolactinomas: CT evaluation of reduction of tumor size after medical treatment. Neuroradiology 23:123–126PubMed Scotti G, Scialfa G, Pieralli S, Chiodini PG, Spelta B, Dallabonzana D (1982) Macroprolactinomas: CT evaluation of reduction of tumor size after medical treatment. Neuroradiology 23:123–126PubMed
20.
go back to reference Dallabonzana D, Spelta B, Oppizzi G, Tonon C, Luccarelli G, Chiodini PG, Liuzzi A (1983) Reenlargement of macroprolactinomas during bromocriptine treatment: report of two cases. J Endocrinol Invest 6:47–50PubMed Dallabonzana D, Spelta B, Oppizzi G, Tonon C, Luccarelli G, Chiodini PG, Liuzzi A (1983) Reenlargement of macroprolactinomas during bromocriptine treatment: report of two cases. J Endocrinol Invest 6:47–50PubMed
21.
go back to reference Lundin P, Bergstrom K, Nyman R, Lundberg PO, Muhr C (1992) Macroprolactinomas: serial MR imaging in long-term bromocriptine therapy. AJNR Am J Neuroradiol 13:1279–1291PubMed Lundin P, Bergstrom K, Nyman R, Lundberg PO, Muhr C (1992) Macroprolactinomas: serial MR imaging in long-term bromocriptine therapy. AJNR Am J Neuroradiol 13:1279–1291PubMed
22.
go back to reference Kupersmith MJ, Kleinberg D, Warren FA, Budzilovitch G, Cooper P (1989) Growth of prolactinoma despite lowering of serum prolactin by bromocriptine. Neurosurgery 24:417–423PubMedCrossRef Kupersmith MJ, Kleinberg D, Warren FA, Budzilovitch G, Cooper P (1989) Growth of prolactinoma despite lowering of serum prolactin by bromocriptine. Neurosurgery 24:417–423PubMedCrossRef
23.
go back to reference Saeki N, Nakamura M, Sunami K, Yamaura A (1998) Surgical indication after bromocriptine therapy on giant prolactinomas: effects and limitations of the medical treatment. Endocr J 45:529–537PubMedCrossRef Saeki N, Nakamura M, Sunami K, Yamaura A (1998) Surgical indication after bromocriptine therapy on giant prolactinomas: effects and limitations of the medical treatment. Endocr J 45:529–537PubMedCrossRef
Metadata
Title
Is a stable or decreasing prolactin level in a patient with prolactinoma a surrogate marker for lack of tumor growth?
Authors
Abdulrahman G. Alkabbani
Sann Y. Mon
Betul Hatipoglu
Laurence Kennedy
Charles Faiman
Robert J. Weil
Amir H. Hamrahian
Publication date
01-04-2014
Publisher
Springer US
Published in
Pituitary / Issue 2/2014
Print ISSN: 1386-341X
Electronic ISSN: 1573-7403
DOI
https://doi.org/10.1007/s11102-013-0473-5

Other articles of this Issue 2/2014

Pituitary 2/2014 Go to the issue