Summary:
Aim: To asses the clinical, hormonal and radiological features of patients with
prolactinoma at diagnosis, to describe the effect of treatment interventions
and the long term outcome under treatment and after therapy withdrawal.
Patients and methods: This is a retrospective study. One hundred seventy-five
patients (79 micro- and 96 macroprolactinomas) diagnosed with prolactinoma
between 1/01/1970 and 31/12/2010. The patients were divided into two groups,
based on the date of introduction of MRI (1990) as the main method of imaging
of pituitary adenomas. Group A consisted of 76 patients diagnosed before 1990
(33 micro- and 43 macroprolactinomas, 19 males and 57 females, mean age at
diagnosis 31,7±1,4 years) and group B of 99 patients diagnosed after 1990 (46
micro- and 53 macroprolactinomas, 35 males and 64 females, mean age at
diagnosis 34,8±1,7 years). Results: Prolactin levels at diagnosis were
602,9±161,4ng/ml in group A and 1206,8±331,9ng/ml in group B and were higher in
macroprolactinomas. The clinical symptoms at the time of diagnosis were
depended on the size of the adenoma and the sex of patients. Dopamine agonist
was used for 39 patients in group A and 83 patients in group B. A total of 23
patients were treated with surgical removal of adenoma (16 patients in group A
and 7 patients in group B) and radiation was needed in a total of 11 patients
(9 patients in group A and 2 patients in group B). The above mentioned
therapeutic interventions were effective in reversing the hypogonadism,
normalizing prolactin levels and reducing the size of the adenoma in 40,9% of
patiens with microprolactinomas and of patients 61,7% of patients with
macroprolactinomas. The follow-up for the 91 patients presented (44 micro- and
47 macroprolactinomas) was 139,2±49,1 months for micro- and 88,2±13,9 months
for macroprolactinomas. For 47 patients, dopamine agonist withdrawal was
decided. After a median duration of treatment of 5 years and a mean follow-up
time after withdrawal of 2,2 years, 56,6% showed recurrence and 40,4% showed
remission. Conclusion: The clinical symptoms at the diagnosis were depended on
the size of the adenoma and the sex of patients and did not differ from the
classic description of the disease. Depending on the time of diagnosis (before
or after 1990) we observed a different way of managing these patients. Most of
the patients diagnosed before 1990 were treated with bromocriptine, had
undergone surgery and radiation without disease control. The recurrence of
patients after about 5 years of therapy was 56,6% at 26,5 months after dopamine
agonist withdrawal.
Keywords:
Prolactin, Prolactinomas, Dopamine agonist, Long term follow-up
