DEMOGRAPHIC CHARACTERISTICS, PRESENTATIONS AND TREATMENT OUTCOME OF PATIENTS WITH PROLACTINOMA

Authors

  • Sarwar Malik
  • Syed Zubair Hussain
  • Rabia Basit
  • Najia Idress
  • Aysha Habib
  • Muhammad Zaman
  • Najmul Islam

Abstract

Background: Prolactinomas are the most common type of functional pituitary tumours. The objective of this study was to determine demographic profile of patients with prolactinomas, and to compare the outcomes in patients treated with Cabergoline versus those receiving Bromocriptine treatment. Methods: This descriptive study was conducted at Endocrinology Section, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan. We reviewed the medical record of 68 patients with prolactinoma. Data about demographic characteristics, clinical presentation and treatment were entered on a pre-designed pro forma. Results: Out of the total 68 patients, 36.8% were males and 63.2% were females, with a mean age of 34±10.7 years. The most frequent presenting complaint amongst the patients was of headache, present in 57.4% patients. Galactorrhea, amenorrhea and infertility were next highest reported symptoms. Results of the tumour size on initial MRI showed macroprolactinomas 52.9% (36), microprolactinomas in 33.8% (23), and giant prolactinomas in 13.3 % (9) patients. Decreasing trend of prolactin levels were also seen on follow up visits at 9 months and 12 months. Tumour size was decreased in 48.53% (33) patients and lesion completely disappeared in 16.18% (11) patients after 6 months of treatment and also almost similar trend in tumour size change was seen after one year. There was no significant difference between the two drugs in bringing prolactin to normal range at each follow up duration. Conclusion: Most of the prolactinoma patients were females and the common the most frequent presenting complaint was headache. The decreasing trend of serum prolactin and tumour size reduction in patients was noted, suggesting the beneficial impact of medical therapy as it is the first line treatment modality in these patients.Keywords: Prolactinoma, Prolactin, Tumour size, Bromocriptine, Cabergoline

References

Fideleff HL, Boquete HR, Suarez MG, Azaretzky M. Prolactinoma in children and adolescents. Horm Res 2009;72:197–205.

Ciccarelli A, Daly AF, Beckers A. The Epidemiology of Prolactinomas. Pituitary 2005;8:3–6.

Oh C, Kunwar S, Blevins L, Aghi MK.. Medical versus surgical management of prolactinomas. Neurosurg Clin N Am 2012;23:669–78.

Moraes AB, Silva CM, Vieira Neto L, Gadelha MR. Giant prolactinomas: the therapeutic approach. Clin Endocrinol (Oxf). 2013;79:447-56

Colao A, Sarno AD, Cappabianca P, Briganti F, Pivonello R, Somma CD, et al. Gender differences in the prevalence, clinical features and response to cabergoline in hyperprolactinemia. Eur J Endocrinol. 2003;148:325–31.

Javorsky BR, Findling JW. Hypothalmus and pituitary gland. In: Gardner DG, Shoback D, editors. Greenspan’s basic and clinical endocrinology. 9th ed. USA: McGraw Hill; 2011.p. 65–114.

Behari S. Management of prolactinomas: The fine print between the lines! Neurol India 2011;59:501–3.

Singh P, Singh M, Cugati G, Singh AK. Bromocriptine or cabergoline-induced cerebrospinal fluid rhinorrhea: A life-threatening complication during management of prolactinoma. J Hum Reprod Sci 2011;4:104–5.

Colao A, di Somma C, Pivonello R, di Sarno A, Lombardi G. Dopamine receptor agonists for treating prolactinomas. Expert Opin Investig Drugs 2002;11:787–800

Ding D, Starke RM, Sheehan JP. Treatment paradigms for pituitary adenomas: defining the roles of radiosurgery and radiation therapy. J Neurooncol 2014;117:445–57.

Ishtiaq O, Haq MU, Rizwan A, Masood MQ, Mehar S, Jabbar A. Etiology, functional status and short term outcome of patients with pituitary lesions. An experience from a developing country. J Pak Med Assoc 2009;59:839–43.

Shamim MS, Bari ME, Khursheed F, Jooma R, Enam SA. Pituitary adenomas: presentations and outcomes in a South Asian country. Can J Neurol Sci 2008;35:198–203.

Mindermann T, Wilson CB. Age-related and gender-related occurrence of pituitary adenomas. Clin Endocrinol (Oxf) 1994;41:359–64.

Lamberts SW, de Herder WW, Kwekkeboom DJ, vd Lely AJ, Nobels FR, Krenning E. Current tools in the diagnosis of pituitary tumours. Acta endocrinol (Copenh) 1993;129(Suppl 1):6–12.

Pinzone JJ, Katznelson L, Danila DC, Pauler DK, Miller CS, Klibanski A. Primary Medical Therapy of Micro-and Macroprolactinomas in Men 1. J Clin Endocrinol Metab 2000;85:3053–7.

Colao A, Di Sarno A, Guerra E, De Leo M, Mentone A, Lombardi G. Drug insight: Cabergoline and bromocriptine in the treatment of hyperprolactinemia in men and women. Nat Pract Clin Endocrinol Metob 2006;2:200–10.

Molitch ME. Medical management of prolactin-secreting pituitary adenomas. Pituitary 2002;5(2):55–65.

Sabuncu T, Arikan E, Tasan E, Hatemi H. Comparison of the effects of cabergoline and bromocriptine on prolactin levels in hyperprolactinemic patients. Intern Med 2001;40:857–61.

Published

2014-09-01

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