Article

Giant prolactinomas in women.

E Delgrange, Endocrinology, Université Catholique de Louvain, Mont-sur-Meuse, 5530, Belgium.
European Journal of Endocrinology (Impact Factor: 3.69). 10/2013; DOI: 10.1530/EJE-13-0503
Source: PubMed

ABSTRACT to characterize distinctive clinical features of giant prolactinomas in women.
a multicentre retrospective case series and literature review.
we collected data from 15 female patients with a pituitary tumour larger than 4 cm and prolactin levels above 1,000 µg/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.
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 6 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 to 35 years in men (p<0.05). All cases diagnosed before the age of 15 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 7 cases of primary amenorrhoea. In 8 women with onset of secondary amenorrhoea before age 40, the diagnosis was made 2 to 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 2 of them. Eighteen patients were treated with cabergoline; standard doses (< 2.0 mg/week) were able to normalize prolactin in only 4/18 patients, and 7/18 were resistant to weekly doses ranging from 3.0 to 7.0 mg.
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.

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Available from: Gérald Raverot, Mar 31, 2015
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