SFEBES2025 Oral Communications Neuroendocrinology and Pituitary (6 abstracts)
Management of cystic macroprolactinoma – a UK & ireland multicentre study
David S. McLaren 1 , Kenal Patel 1 , Muhammad Chohan 2 , Darran McDonald 3 , Ali Al Jumaah 4 , Masato Ahsan 4 , Arwa Alyamani 5 , Harsha Dissanayake 6 , Sophie A Buckley 7 , P. Benjamin Loughrey 8 , Vincent Simpson 9 , Kyi P. Than Yu 10 , Aftab Ahmed 11 , Delanos Bramble 12 , Janki Panicker 13 , Sherwin Criseno 5 , John Ayuk 5 , Khyatisha Seejore 1 , Nikolaos Kyriakakis 1 , Julie Lynch 1 , Tejpal Purewal 13 , Ketan Dhatariya 14 , Daniel Flanagan 12 , Andrew Lansdown 11 , Niamh Martin 15 , Biju Jose 10 , Bijay Vaidya 9 , Steven Hunter 8 , Stephanie E. Baldeweg 16 , Jan Hoong Ho 17 , William M Drake 7 , Aparna Pal 6 , Niki Karavitaki 5 , Narendra Reddy 4 , John Newell-Price 18 , Ziad Hussein 18,16 , Mark Sherlock 3 , Yaasir Mamoojee 2 & Robert D. Murray 1
1Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom; 2The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom; 3Beaumont Hospital, Dublin, Ireland; 4University Hospitals of Leicester NHS Trust, Leicester, United Kingdom; 5Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom; 6Oxford University Hospitals, Oxford, United Kingdom; 7St Bartholomew’s Hospital, London, United Kingdom; 8Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, United Kingdom; 9Royal Devon University Healthcare NHS Foundation Trust, Devon, United Kingdom; 10University Hospitals of North Midlands NHS Trust, Staffordshire, United Kingdom; 11University Hospital of Wales & Cardiff, Cardiff, United Kingdom; 12University Hospitals Plymouth, Plymouth, United Kingdom; 13Liverpool University Hospitals Foundation Trust, Liverpool, United Kingdom; 14Norfolk & Norwich NHS Foundation Trust, Norwich, United Kingdom; 15Imperial College Healthcare NHS Trust, London, United Kingdom; 16University College London Hospitals NHS Foundation Trust, London, United Kingdom; 17The Christie NHS Foundation Trust, Manchester, United Kingdom; 18University of Sheffield and Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
Background: Prolactinomas are managed primarily using dopaminergic agonists (DA). Cystic macroprolactinomas have been considered an exception to this rule, particularly when the chiasm is involved as the cystic component is considered less likely to respond to DA.
Methods: Data were collected regarding management of cystic macroprolactinomas from 18 UK and Irish endocrine centres. Cystic macroprolactinomas were defined as >10mm, cystic component >50% adenoma diameter and prolactin >2000mIU/l.
Results: 117 patients were identified meeting the inclusion criteria (median age at presentation 32.0, IQR 21.0-50.0yrs, 57F). Of these, 14 presented with apoplexy. Of the remaining 103 patients, three underwent primary surgery for visual field (VF) deficits. Decompression of the chiasm and restoration of VFs was achieved in all, however, all remain on DA. One hundred patients received DA as primary therapy (median age 36.5, IQR 20.0-50.3yrs; 51F; median duration 50, IQR 10.0-93.3mths). Cabergoline was the DA of choice (n = 99; median dose 1.0, IQR 0.5-1.5 mg/wk). At last follow-up, prolactin levels had declined from 9863 (IQR 4099-25369)mIU/L to 390 (IQR 125-954)mIU/l. Tumour shrinkage occurred in 79, with reduction in median adenoma and cyst diameter from 18.0 (IQR 14.0-26.0)mm and 13.5 (IQR 7.0-18.0)mm to 14 (IQR 11.0-19.0)mm and 8.3 (IQR 4.3-13.0)mm respectively. Baseline chiasmal compression and VF defects were present in 37 and 30 respectively. Of these, 27 showed relief of chiasmatic compression and 20 improved VFs. Four showed no improvement in either chiasmal compression or VFs; data were not available for six. Seventeen patients underwent surgery as secondary treatment for persistent VF defects, failure of tumour shrinkage/enlargement, or DA intolerance. Of these, 11 remain on DA. Five patients experienced apoplexy during treatment.
Conclusions: These data support a high degree of efficacy for primary DA therapy in cystic macroprolactinoma and provide data helpful to inform outcomes.
Volume 109
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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