PNA Medical Corner: MRIs and Macroprolactinomas
This month the PNA Medical Corner focuses on a study coauthored by PNA-member Dr. Albert Beckers. It explains why MRIs are not necessary for patients with large prolactinomas and normal prolactin levels when treated with a dopamine agonist.
MRI follow-up is unnecessary in patients with macroprolactinomas and long-term normal prolactin levels on dopamine agonist treatment.
Eroukhmanoff J1, Tejedor I2, Potorac I3, Cuny T4, Bonneville JF5, Dufour H6, Weryha G7, Beckers A8, Touraine P9, Brue T10, Castinetti F11.
Both antitumor and antisecretory efficacies of dopamine agonists (DA) make them the first line treatment of macroprolactinomas. However, there is no guideline for MRI follow-up once prolactin is controlled. The aim of our study was to determine whether a regular MRI follow-up was necessary in patients with long-term normal prolactin levels under DA. PATIENTS AND METHODS We conducted a retrospective multicenter study (Marseille, Paris La Pitie Salpetriere and Nancy, France; Liege, Belgium) including patients with macroprolactinomas (largest diameter > 10 mm, baseline prolactin level > 100 ng/mL) treated by dopamine agonists, and regularly followed (pituitary MRI and prolactin levels) during at least 48 months once normal prolactin level was obtained. RESULTS 115 patients were included (63 men and 52 women; mean age at diagnosis, 36.3 years). Mean baseline prolactin level was 2224 ± 6839 ng/mL. No significant increase of tumor volume was observed during the follow-up. Among 21 patients (18%) who presented asymptomatic hemorrhagic changes of the macroprolactinoma on MRI, 2 had a tumor increase (2 and 7 mm in the largest size). Both were treated by cabergoline (1 mg/week) with normal prolactin levels obtained for 6 and 24 months. For both patients, no further growth was observed on MRI during follow-up at the same dose of cabergoline. CONCLUSION No significant increase of tumor size was observed in our patients with controlled prolactin levels on DA. MRI follow-up thus appears unnecessary in patients with biologically controlled macroprolactinomas.