Clinical and Biochemical Characteristics of a Cohort of Patients with Prolactinomas at a University's Hospital

Presentation Number: SAT 412
Date of Presentation: April 1st, 2017

Mariana Soledad Gonzalez Pernas1, Soledad Sosa1, Joanna Milena Márquez Fernández2, Marcos Manavela3, Graciela Cross4 and Karina Danilowicz*5
1Hospital de Clínicas "José de San Martín" Universidad de Buenos Aires, 2Universidad de Antioquia, 3Consultorios de Endocrinología Dr Manavela, Caba, Argentina, 4Hospital de Clínicas “José de San Martín” Universidad de Buenos Aires, Argentina, 5Hospital de Clínicas “José de San Martín” Universidad de Buenos Aires., Buenos Aires, Argentina

Abstract

Prolactin-secreting adenomas (PA) are the most frequent pituitary adenoma, accounting for 40-60%. Incidence prevails in young females (F), between 25-35 years old (yo) and at an older age in men (M). The purposes of this report were to analyze the presentation of PA in a cohort of patients and the therapeutic outcomes.

Data was retrospectively collected from clinical records of patients followed up between June 1992 and May 2016. Tumor size (TS, MI < 10 mm, MA ≥ 10mm) and basal prolactin levels (bPRL, ng/ml) were registered. Biochemical and radiological responses were evaluated during the follow-up (F/U).

Response to dopaminergic agonists (DA) was defined as 50% reduction of TS and/or PRL. Resistance (R) was considered as the absence of response despite CBG dose > 3.5 mg/weekly (w). Statistical software corresponded to SPSS 20.0

Among 1040 patients with pituitary adenomas, 209 PA (19.8%) were identified: 60.2% MA (n=124) and 39.8% MI (n=82). Gender distribution according to TS was 70 F and 54 M in MA and 75 F and 7 M in MI (p<0.001). 99 patients were included for analysis of F/U: 71 F (29.4±12.3 yo) and 28 M (40.6±13.8 yo) (p<0.001 regarding gender and age); 68.7% were MA (23±12.8 mm) and 31.3% MI (5.7±1.8 mm). Mean bPRL was 2707.6±6564.4 (90-33000) in MA and 120.6±84.5 (54.4-349) in MI.

After age subgroup distinction (<25 vs ≥ 45 yo), significant differences were found regarding TS (p=0.02) and bPRL (p=0.03).

The most common initial complaints were menstrual abnormalities 50%, galactorrhea 30.4%, visual defects 27.9%, headache 19.6%, infertility 15.7% and decreased libido 8.8%.

As initial treatment (T) 81.8% received CBG and 18.2% BEC, with median dose of 1 (0.25-13) mg/w and 5 (1.25-20) mg/day, respectively. Mean duration of T was 41.9±36.4 months (6-204).

Treatment achieved PRL normalization in 87.8% (n=87) and TS reduction in 48.5% (n=48). Accordingly to age subgroups, no differences were present regarding T duration, complete tumor disappearance and PRL normalization.

R was found in 15.1% (n=15), without differences in relation to age, contrary to bPRL (5360.9±9236.5 vs 1239.1±4350; p<0.001) and TS (28.9±17 vs 15.6±11.6; p=0.002). A higher proportion corresponded to MA (p=0.002) and M (p=0.002). T withdrawal was reached in 36.4% (n=36), with MI preponderance and recurrence documentation in 33.3% (n=12).

In discrepancy with most reports, a fewer PA frequency was found in this cohort, with predominance of MA, since ours is a neurosurgical reference centre. As expected, the majority of patients achieved response with low CBG doses, regardless of TS, with PRL reduction and TS shrinkage. Younger patients presented with larger TS and higher bPRL; however no differences were established in T response. In concordance with most important series, CBG R was uncommon, prevailing in MA and M, associated with higher bPRL and larger TS. Recurrence observed in this cohort was 33.3%

 

Disclosure: MM: , Novartis Pharmaceuticals. Nothing to Disclose: MSG, SS, JMM, GC, KD