Endocrine Abstracts

JOINT2513

Introduction: Aggressive prolactinomas (APRL) constitute a subgroup of aggressive PitNets. Their distinguishing features constitute invasion (radiological/histological), high proliferation profile, resistance to standard medication, and an increased risk of early recurrence.

Objectives: To analyse the clinical course and the systemic inflammation biomarkers in aggressive prolactinomas.

Methods: Data concerning clinical course, radiological invasion, systemic inflammation biomarkers (SIBs), and treatment of APRL were analyzed.

Results: 22 cases of APRL: 4 women (18.2%) and 18 men (81.2%), among which 14 constituted giant tumors (>4 cm) were analyzed. The most frequent symptoms included headaches 5/22 (68%) and vision disturbances 10/22 (45.5%). 50% of women noticed menstrual cycle alterations and galactorrhea. 4/18 (22.2%) of men reported libido loss. According to the MRI, in 15/22(68.2%), the tumor infiltrated the optic chiasm; in 20/22 (90.9%), the cavernous sinuses (in 17/22, infiltration included ICA). 52.4% (11/21) of tumors were grade 4 in the Knosp classification. In 9/22 (40.9%), we observed insufficiency of the gonadal, adrenal, and thyroid axis; in 10/22 (45.5%) - isolated gonadal axis dysfunction. All the patients were treated with dopamine agonists (predominantly cabergoline - 19/22 (86.4%), an average weekly dose of 2.5mg (max-4.5; min-1). In the group of giant tumors (G) the average dose of cabergoline was 2.5 mg/week, while in the non-giant (nG) group 2.25 mg/week. 5/22 (22.7%) patients undergone the surgery (2 patients more than one). One patient received radiotherapy. Other therapeutic options included temozolomide (1/22), pasireotide (1/22), and lanreotide (3/22). When comparing a G group with nG, we observed that the Neu/lymph ratio and Plt/lymph were higher in the G group (2.87 vs. 1.46, P = 0.007; 164.4 vs. 103.58, P = 0.068). Moreover, baseline prolactin level (upper normal limit (UNL)) was higher in the G (1232xUNL) vs nG group (141xUNL), P = 0.059. The average reduction in prolactin levels was less significant in the G group – 78.7% (0-99.7%) vs. 87.5% (39.4%-99.73%) in the nG group.

Conclusion: The clinical course of the disease and SIBs differ between giant and not-giant aggressive prolactinomas. Further studies are needed to understand the nature of this condition.

Keywords: Aggressive prolactinoma, prolactinoma, cabergoline, pasireotide.