ECE2021 Audio Eposter Presentations Pituitary and Neuroendocrinology (113 abstracts)
Third month MRI predicts macroprolactinoma reduction after cabergoline therapy
Betina Biagetti 1 , Silvana Sarria-Estrada 2 , Karelis Ng-Won 2 , Martinez-Saez Elena 2 , Anna Casteras 2 , Cordero-Asanza Esteban 2 , Irene Hernández-Hernández 2 , Efrain Cordero-Vazquez. 2 , Rojano Alba 2 & Rafael Simo Canonge 2
1Vall d’Hebron University Hospital, Endocrinology, Barcelona, Spain; 2Hospital Universitari Vall d’Hebron, Barcelona, Spain
Background
Transsphenoidal surgery is in general the preferred first-line treatment for patients with macroadenomas except for prolactinomas, which is mainly indicated when the treatment with dopamine agonists (DA) fails. However, in those patients resistant to DA (i.e. volume reduction < 50% in the follow-up) this strategy delays the surgical procedure.
Objective
To identify predictors of DA resistance in order to select patients who may benefit from early surgery.
Methods
We retrospectively analysed a database of a tertiary reference centre searching for patients diagnosed of prolactinoma after 2010 (when medical records were computerized) and with active follow up in the last five years. The adenoma volume was analysed by MRI before 3 and 12 months of treatment. We used spearman rank to investigate if our main outcome: (volume reduction of ≥ 50% after 12 months of treatment with DA therapy), was influenced by several variables including age, gender, prolactin levels, DA doses and adenoma volume reduction at 3–4 month of treatment.Finally we tested by logistic regression which variables predict better the main outcome.
Results
A total of 185 prolactinomas where included: 124 (67.0 %) were microadenomas and 61 (33.0%) were macroadenomas. We excluded 28 patients with incomplete data or diagnosed before 2010 and 6 patients that underwent surgery in first line. Finally, 27 patients meet de inclusion criteria; mean age [44.4 years; CI 95%: (37.8–59.8)].), of whom 10 were women (37.0%) and 17 were men (63.0%). Mean follow up [67.5 months; CI 95%: (52.5.0–82.7)]. Ten (37.0%) patients (8 males: 80.0%) underwent surgery after more than one year of DA because a lack of tumour reduction. The volume reduction at the first MRI (3–4 months) was the unique valuable predictor: [OR: 1.16 (IC 95% 1.02–1.32)]. A cut off tumour volume reduction ≥ 35% by the first 3–4 months of DA therapy predicted subsequent volume reduction > 50% in the first year with an AUC 0.95 [CI: (0.76–0.99)].
Conclusion
The tumor shrinkage in the first 3–4 month after starting treatment with DA is the best predictor of future volume reduction resistance. These results could help in decision-making regarding the management of macroprolactinomas.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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