RESUMO
The purpose of this case series is to report eight patients with giant prolactinomas emphasizing presentations and a treatment complication. The study group included six men and two women. The median age was 29 years (18-54 years); median serum prolactin level was 4,562 ng/ml (1,543-18,690 ng/ml); three patients (37.5%) had panhypopituitarism; median tumor diameter was 50 mm (41-60 mm). Five patients (62.5%) had visual field defects and three had improvement during treatment; six patients (75%) reached prolactin normalization, with a median time of 10.5 months (7-84 months) and median dose of 2.0 mg/week (1.0 to 3.0 mg/week). One patient presented as a true incidentaloma. One patient presented a cerebrospinal fluid leakage during medical treatment and refused surgery, however this resolved with conservative measures. This case series illustrate a rare subtype of macroprolactinomas, the importance of considering unusual presentations at the diagnosis, the effectiveness of pharmacological treatment and its possible complications.
Assuntos
Neoplasias Hipofisárias/patologia , Neoplasias Hipofisárias/terapia , Prolactinoma/patologia , Prolactinoma/terapia , Adolescente , Adulto , Antineoplásicos/uso terapêutico , Cabergolina , Vazamento de Líquido Cefalorraquidiano/patologia , Agonistas de Dopamina/uso terapêutico , Ergolinas/uso terapêutico , Feminino , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias Hipofisárias/diagnóstico por imagem , Prolactina/sangue , Prolactinoma/diagnóstico por imagem , Sela Túrcica/patologia , Fatores de Tempo , Resultado do Tratamento , Carga Tumoral , Adulto JovemAssuntos
Fármacos do Sistema Nervoso Central/uso terapêutico , Agonistas de Dopamina/efeitos adversos , Frutose/análogos & derivados , Transtornos de Enxaqueca/tratamento farmacológico , Transtornos de Enxaqueca/etiologia , Neoplasias Hipofisárias/complicações , Prolactinoma/complicações , Encéfalo/diagnóstico por imagem , Cabergolina , Criança , Agonistas de Dopamina/uso terapêutico , Ergolinas/efeitos adversos , Ergolinas/uso terapêutico , Frutose/uso terapêutico , Humanos , Masculino , Transtornos de Enxaqueca/diagnóstico por imagem , Transtornos de Enxaqueca/metabolismo , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/tratamento farmacológico , Neoplasias Hipofisárias/cirurgia , Prolactinoma/diagnóstico por imagem , Prolactinoma/tratamento farmacológico , Prolactinoma/cirurgia , TopiramatoRESUMO
ABSTRACT The purpose of this case series is to report eight patients with giant prolactinomas emphasizing presentations and a treatment complication. The study group included six men and two women. The median age was 29 years (18–54 years); median serum prolactin level was 4,562 ng/ml (1,543–18,690 ng/ml); three patients (37.5%) had panhypopituitarism; median tumor diameter was 50 mm (41–60 mm). Five patients (62.5%) had visual field defects and three had improvement during treatment; six patients (75%) reached prolactin normalization, with a median time of 10.5 months (7–84 months) and median dose of 2.0 mg/week (1.0 to 3.0 mg/week). One patient presented as a true incidentaloma. One patient presented a cerebrospinal fluid leakage during medical treatment and refused surgery, however this resolved with conservative measures. This case series illustrate a rare subtype of macroprolactinomas, the importance of considering unusual presentations at the diagnosis, the effectiveness of pharmacological treatment and its possible complications.
RESUMO O objetivo desta série de casos é relatar oito pacientes com prolactinomas gigantes enfatizando as formas de apresentação e uma complicação do tratamento. O estudo incluiu seis homens e duas mulheres. A mediana de idade foi 29 anos (18–54); e dos níveis de prolactina foi 4.562 ng/ml (1.543–18.690); três pacientes (37,5%) apresentaram pan-hipopituitarismo; a mediana do máximo diâmetro tumoral foi 50 mm (41–60 mm). Cinco pacientes (62,5%) apresentaram alterações no campo visual e três tiveram melhora durante o tratamento; seis pacientes (75%) alcançaram normalização da prolactina em 10,5 meses (7–84) com dose mediana de cabergolina de 2,0 mg / semana (1,0 a 3,0). Um paciente se apresentou como um verdadeiro incidentaloma. Um paciente apresentou uma fistula liquórica durante o tratamento medicamentoso e recusou correção cirúrgica. No entanto a fistula foi resolvida com medidas conservadoras. Esta série de casos ilustra um subtipo raro de macroprolactinomas, a importância de considerar apresentações incomuns no diagnóstico, a eficácia do tratamento farmacológico e suas possíveis complicações.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Neoplasias Hipofisárias/patologia , Neoplasias Hipofisárias/terapia , Prolactinoma/patologia , Prolactinoma/terapia , Neoplasias Hipofisárias/diagnóstico por imagem , Prolactina/sangue , Sela Túrcica/patologia , Fatores de Tempo , Imageamento por Ressonância Magnética , Prolactinoma/diagnóstico por imagem , Seguimentos , Resultado do Tratamento , Agonistas de Dopamina/uso terapêutico , Carga Tumoral , Ergolinas/uso terapêutico , Vazamento de Líquido Cefalorraquidiano/patologia , Cabergolina , Antineoplásicos/uso terapêuticoRESUMO
OBJECTIVES: (1) to evaluate bone density in women with prolactinoma treated with dopamine agonists and healthy controls, using dual energy x-ray absorptiometry (DXA), (2) to classify the results according to the current International Society for Clinical Densitometry (ISCD) criteria, and (3) to correlate bone density with lean and fat masses, biochemical data and clinical aspects of prolactinomas. MATERIALS AND METHODS: A cross-sectional study was performed in two University referral centers. Forty-five premenopausal women with prolactinoma were submitted to DXA and blood analysis (prolactin, estradiol, testosterone, SHBG, calcium, phosphorus, PTH, C-telopeptides of type 1 collagen, and osteocalcin) by the time of their clinical evaluation. They were compared with 25 control women of similar age and body mass index distribution. RESULTS: Women with prolactinoma had lower lumbar spine Z-score than controls. Femoral neck, trochanter, and total proximal femur Z-scores were similar in patients and controls. Twenty-two percent of the patients had Z-scores below the expected age range vs. 4% in the control group. Lumbar spine, femoral neck, and total proximal femur Z-scores were mainly correlated with the amenorrhea duration. The trochanter Z-score was associated with the gynoid lean/fat mass ratio. CONCLUSIONS: Based on the current ISCD criteria, bone density evaluation in women with prolactinoma reveals bone loss, especially of trabecular type. Bone density in these patients was particularly associated with the duration of amenorrhea, which reinforces the importance of the adequate disease control in women with prolactinoma in order to avoid complications of this disease.
Assuntos
Densidade Óssea/efeitos dos fármacos , Doenças Ósseas Metabólicas/prevenção & controle , Agonistas de Dopamina/uso terapêutico , Neoplasias Hipofisárias/tratamento farmacológico , Prolactinoma/tratamento farmacológico , Absorciometria de Fóton , Adulto , Amenorreia/etiologia , Amenorreia/prevenção & controle , Biomarcadores/sangue , Composição Corporal , Doenças Ósseas Metabólicas/sangue , Doenças Ósseas Metabólicas/diagnóstico por imagem , Doenças Ósseas Metabólicas/etiologia , Brasil , Estudos de Casos e Controles , Estudos Transversais , Estradiol/sangue , Feminino , Humanos , Análise Multivariada , Neoplasias Hipofisárias/sangue , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/diagnóstico por imagem , Pré-Menopausa , Prolactina/sangue , Prolactinoma/sangue , Prolactinoma/complicações , Prolactinoma/diagnóstico por imagem , Fatores de Risco , Resultado do TratamentoRESUMO
Pituitary carcinomas are rare neoplasms characterized by craniospinal and/or systemic metastases originated from the pituitary. Their histopathology is frequently indistinguishable from that of benign adenomas. The development of markers that better reflect their behavior is desirable. We present the case of a 47 year-old man with a prolactin-secreting macroadenoma who was submitted to surgeries, cranial radiation therapy, and bromocriptine treatment, but evolved to a fatal outcome after the disclosure of intracranial metastases. Tumor samples underwent p53 and Ki-67 immunohistochemical assessment. p53 was absent in all samples, a rare finding among pituitary carcinomas. Ki-67 proliferative index was 2.80% in the original tumor, 4.40% in the relapse, and 4.45% in the metastasis. The figure in the relapse is higher than the expected for a noninvasive adenoma. In conclusion, p53 staining is not positive in all pituitary carcinomas. A high Ki-67 proliferative index in a pituitary adenoma might indicate a more aggressive behavior.
Assuntos
Biomarcadores Tumorais/análise , Genes p53 , Antígeno Ki-67/análise , Neoplasias Meníngeas/secundário , Neoplasias Hipofisárias/patologia , Prolactinoma/secundário , Anticorpos Antinucleares/análise , Anticorpos Monoclonais/análise , Biópsia , Evolução Fatal , Humanos , Imuno-Histoquímica , Imageamento por Ressonância Magnética , Masculino , Neoplasias Meníngeas/diagnóstico por imagem , Pessoa de Meia-Idade , Invasividade Neoplásica , Neoplasias Hipofisárias/diagnóstico por imagem , Prolactina/sangue , Prolactinoma/diagnóstico por imagem , Radiografia , Sela Túrcica/diagnóstico por imagem , Sela Túrcica/patologiaRESUMO
A young woman with amenorrhea-galactorrhea induced by a prolactin (PRL) secreting pituitary macroadenoma, was treated with bromocriptine 5 mg/day per os. Serum PRL levels were normal at 6 weeks and menstruation appeared at 8 weeks of treatment. When twenty months of treatment were completed, a tomographic study of the pituitary was unable to show any enlargement. Controversies related to macroprolactinomas treatment are discussed and it is suggested that treatment with dopamine agonists must be the elective treatment for patients with macroprolactinoma.
Assuntos
Amenorreia/etiologia , Bromocriptina/uso terapêutico , Galactorreia/etiologia , Neoplasias Hipofisárias/complicações , Prolactinoma/complicações , Adulto , Bromocriptina/farmacologia , Feminino , Humanos , Neoplasias Hipofisárias/cirurgia , Prolactinoma/diagnóstico por imagem , Remissão Espontânea , Tomografia Computadorizada por Raios XRESUMO
Radiographic computed tomography and magnetic resonance imaging are the procedures of choice in the diagnosis of patients with suspected pituitary gland abnormalities. Several cases are presented where the diagnostic value of such procedures in patients with diseases affecting the pituitary gland is demonstrated.
Assuntos
Adenoma/diagnóstico , Neoplasias Hipofisárias/diagnóstico , Prolactinoma/diagnóstico , Sela Túrcica , Adenoma/diagnóstico por imagem , Adolescente , Adulto , Idoso , Diagnóstico Diferencial , Síndrome da Sela Vazia/diagnóstico , Síndrome da Sela Vazia/diagnóstico por imagem , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Doenças da Hipófise/diagnóstico , Doenças da Hipófise/diagnóstico por imagem , Neoplasias Hipofisárias/diagnóstico por imagem , Pneumoencefalografia , Prolactinoma/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
Two patients harboring invasive macroprolactinomas, on treatment with bromocriptine, developed cerebrospinal fluid rhinorrhea 16 and 17 months after the beginning of the medical therapy. Neither patient had previously been submitted to surgery or radiotherapy. The fistulae were surgically corrected. Cerebrospinal fluid leakage is a well-documented complication of pituitary tumors, mainly after surgery and/or radiotherapy, but the reports of its occurrence after primary treatment with bromocriptine are rare. Therefore, the possibility of this complication must be considered, especially in patients with invasive macroprolactinomas.