A multicenter study of clinical outcomes and volumetric trends in suspected microprolactinomas.

Autor: Hong CS; Department of Neurosurgery, Computational Neurosciences Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Street, BTM 4, Boston, MA, 02115, USA. chong6@mgb.org.; Division of Neurosurgery, Department of Surgery, VA Boston Healthcare System, Boston, United States. chong6@mgb.org., Chabros J; Department of Neurosurgery, Computational Neurosciences Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Street, BTM 4, Boston, MA, 02115, USA., Kilgallon JL; Department of Neurosurgery, Computational Neurosciences Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Street, BTM 4, Boston, MA, 02115, USA., Gerstl JVE; Department of Neurosurgery, Computational Neurosciences Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Street, BTM 4, Boston, MA, 02115, USA., Omara C; Department of Neurosurgery, Computational Neurosciences Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Street, BTM 4, Boston, MA, 02115, USA.; Department of Neurosurgery, Leiden University Medical Center, Leiden, Netherlands., Drexler R; Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Flitsch J; Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Ricklefs FL; Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Ryba AS; Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Mazzatenta D; IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy., Guaraldi F; IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy., Corrales CE; Department of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA., Min L; Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA., Smith TR; Department of Neurosurgery, Computational Neurosciences Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Street, BTM 4, Boston, MA, 02115, USA.
Jazyk: angličtina
Zdroj: Neurosurgical review [Neurosurg Rev] 2024 Sep 28; Vol. 47 (1), pp. 703. Date of Electronic Publication: 2024 Sep 28.
DOI: 10.1007/s10143-024-02951-7
Abstrakt: The diagnosis of pituitary microprolactinomas is often obscured by relatively low levels of elevated prolactin compared to macroprolactinomas. This may lead to varying patterns of medical therapy versus observation. We sought to correlate prolactin levels in suspected microprolactinomas with tumor volumes and clinical outcomes. This was a multicenter retrospective study of patients with pituitary microadenomas with baseline prolactin levels > 18ng/ml for males and > 30ng/ml for females. A linear-mixed model was used to depict changes in tumor volume over time. There were 65 patients with a mean tumor volume of 95.9mm 3 and mean prolactin level of 59.4ng/ml. There were significantly higher prolactin levels in patients with tumors above the mean volume versus below (74.0 versus 53.4ng/ml, p = 0.027). 26 patients were observed, 31 were treated with anti-dopaminergic therapy, and 8 had surgery. There were significantly greater baseline prolactin levels for patients who were treated surgically (mean 86.4ng/ml) than those treated medically (mean 61.7 g/ml) or observed (mean 48.5ng/ml) (p = 0.02). Among the 26 patients who were surveilled, 13 patients demonstrated spontaneous tumor shrinkage, 12 remained stable, and 1 patient's tumor grew but was lost to follow-up. Linear mixed modeling demonstrated a statistically significant rate of tumor shrinkage over time of 3.67mm 3 /year (p = 0.03). When analyzing patients who were observed versus those requiring surgery after initially being surveilled, there were significantly greater baseline PRL/volume ratios in surgical patients versus those observed (8.1 ng/ml/mm 3 versus 2.4 ng/ml/mm 3 , p = 0.025). Suspected microprolactinomas may demonstrate more convincingly elevated prolactin levels when measuring over 95.9mm 3 . Tumors with baseline prolactin levels over 50ng/ml may be more inclined to undergo medical treatment. In tumors with levels below 50ng/ml, it may be reasonable to undergo surveillance as these tumors tend to spontaneously shrink over time. In tumors that are surveilled, an elevated baseline PRL/volume ratio of > 8 ng/ml/mm 3 may be indicate serial tumor growth that may necessitate medical and/or surgical intervention.
(© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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