Evaluation of pulmonary side effects in prolactinoma patients treated with cabergoline

Introduction: Cabergoline (CAB) is the most used dopamine agonist in the treatment of prolactinomas. Studies related to the treatment of Parkinson’s disease have shown that dopamine agonists can lead to fibrotic syndromes affecting the heart and the lung. The aim of this study was to evaluate the possible pulmonary side effects of CAB in prolactinoma patients. Material and methods: Chest X-ray imaging and pulmonary function parameters like forced vital capacity (FVC), total lung capacity (TLC), and diffusion capacity for carbon monoxide (DLCO) were evaluated in 73 prolactinoma patients. The cumulative dose of CAB and the total duration of CAB use were also calculated, and all data were reviewed retrospectively. Results: The median cumulative CAB dose was 192 mg, and the median duration of CAB use was 64 months. Only 13 patients (17%) among this cohort had abnormal DLCO results that could be an indirect sign of pulmonary fibrosis. These abnormal DLCO results were found not to be associated with cumulative CAB dose in these 13 patients. Conclusions: CAB appears to be safe in terms of pulmonary functions with a median cumulative dose of 192 mg in prolactinoma patients

Time to diagnosis in Cushing’s syndrome: A meta-analysis based on 5367 patients

The time from first symptom to diagnosis of Cushing's syndrome is considered relevant for the severity of phenotype at presentation and long-term outcome. We therefore performed a systematic literature search to investigate relevant factors associated with a short time to diagnosis. The meta-analysis of 45 studies with 5560 patients showed significant differences for adrenal Cushing’s syndrome, Cushing’s disease and the ectopic Cushing’s syndrome. We did not find difference for gender, age or time of publication

Review of Clinical Recommendations on Prolactinoma and Pregnancy

Prolactinomas are the most common hormone-secreting pituitary adenomas. Prolactinomas account for nearly 30-40 percent of all the pituitary adenomas. Although it affects individuals over a wide age range, it is more common in 20-40-year-old female patients, who are in their reproductive age. Prolactinomas may cause hypogonadism, menstrual cycle dysfunction (oligomenorrhea or amenorrhea) and infertility (luteal phase abnormalities or anovulation) in premenopausal women. When pregnancy is excluded, hyperprolactinemia in approximately 10 to 20 percent of the patients results in amenorrhea. Women with untreated pro-lactinomas are generally unable to achieve pregnancy, as the hyperprolactinemia affects the pulsatility of gonadotropin-releasing hormone (GnRH) and diminishes follicle-stimulating hormone (FSH) as well as luteinizing hormone (LH) secretion. The sum of these effects induces amenorrhea, infertility, and hypogonadism, thereby posing difficulties in fertility. Therefore, in most women prolactinoma is diagnosed prior to conception. However, ovulation and fertility usually improve after proper diagnosis and treatment of prolactinoma. Therefore, during the surveillance of these patients, the onset of pregnancy is a common phenomenon. Management of these pregnancies may sometimes be challenging and require a multidisciplinary approach involving an endocrinologist, a gynecologist, a radiologist and an experienced neurosurgeon in order to achieve the best outcomes both for the patient as well the infant. In this report, the authors aim to summarize the consensus statements and the current guidelines for clinical practice

Assessment of macroprolactinemia inpatients with prolactinoma

Purpose: Macroprolactin, the high-molecular mass prolactin isoform, is considered to be an inactive product with extrapituitary origin. Although macroprolactinemia is considered a benign condition, there is evidence of overlapping clinical features among patients with hyperprolactinemia. Data on the prevalence of macroprolactinemia in prolactinomas is also quite limited. The aim of this study was to assess the prevalence of macroprolactinemia in our patients with prolactinoma

Nodular Thyroid Disease and Papillary Thyroid Carcinoma in Functional Pituitary Adenomas

Objective: Increased frequency of nodular thyroid disease has been reported in acromegalic patients. Recent studies have also demonstrated an increased co-existence of nodular thyroid disease with Cushing's disease and prolactinoma. In this study, we evaluated the frequency and outcomes of nodular thyroid disease in each type of functional pituitary adenoma

Withdrawal of dopamine agonist therapy in prolactinomas: In which patients and when?

Purpose The aim of the study was to assess the effect of dopamine agonist (DA) withdrawal, the current recurrence rate of hyperprolactinemia, and possible factors that predict recurrence in patients with prolactinoma

Disease Activity May Not Affect the Prognosis of Coexisting Thyroid Cancer in Acromegalic Patients

Acromegaly is known to be associated with high incidence of malignancies probably due to the mitogenic effects of IGF-1. Differentiated thyroid cancer (DTC) is reported to be one of the most frequent malignancies associated with acromegaly. But there is no data about the clinical course of DTC in acromegalic patients. In this study, we evaluated the course of DTC in 14 acromegalic patients retrospectively. Fourteen papillary thyroid cancer patients without acromegaly, who were matched with the acromegalic patient group for age, gender and properties of thyroid cancer, were investigated as the control group. We identified no change in the course and treatment responses of DTC in association with the acromegaly activity, gender, age and disease duration, and all patients were found to be in remission for DTC at the time of investigation. Retrospective analysis of this cohort suggests that the activity of acromegaly may not affect the treatment responses and prognosis of coexisting DTC

The higher incidence of autoimmune thyroid disease in prolactinomas than in somatotrophinomas

Objective: Many studies have shown that prolactin (PRL) plays an important role in autoimmune diseases. The aim of this study was to compare the current frequency of autoimmune thyroid disease (ATD) in prolactinomas with another type of functional pituitary adenoma (FPA), somatotrophinoma. Another aim of the study was to evaluate possible factors related to thyroid autoimmunity and, the process of ATD in FPAs

Clinical Significance of Granulation Pattern in Corticotroph Pituitary Adenomas

Objective: The granulation pattern of pituitary tumors may be important to predict tumor behavior, treatment outcomes, and recurrences. Therefore, we compared densely granulated corticotroph tumor (DGCT) and sparsely granulated corticotroph tumor (SGCT) in terms of clinicopathologic findings

Evaluation of the natural course of thyroid nodules in patients with acromegaly

PurposeTo investigate the nodular thyroid disease (NTD) and the natural course of thyroid nodules in patients with acromegaly.Methods138 patients with acromegaly (73F/65M), whose initial thyroid ultrasonography performed in our university hospital, were included in this study. The frequencies of NTD, papillary thyroid cancer (PTC) and associated factors on nodule formation were investigated at initial assessment. Patients who had NTD continued to follow-up (n=56) were re-evaluated with a ultrasonography performed after a mean 7-years follow-up period. The nodule size changes were compared with the initial data and the factors affecting nodule growth were investigated.ResultsThe frequency of NTD was found 69%. Patients with NTD were older (p=0.05), with higher baseline IGF-1%ULN (upper limit of normal) (p=0.01). In patients with NTD, the majority had similar nodule size (45%), decreased nodule size in 30% and nodule growth in 25%. In patients with active acromegaly at last visit, nodule growth was more significant (p<0.001). For one unit change in the IGF-1 levels, nodule growth increased by 1.01 folds and presence of active acromegaly disease was related with ninefolds increase in nodule growth. The frequency of PTC was 14% in patients with nodule growth and PTC was diagnosed 11% of all acromegalic patients.ConclusionBoth NTD and nodule growth is more frequent in active acromegalic patients. Thyroid nodules may show dynamic changes according to the disease activity and nodule growth should be closely monitored due to the risk of malignancy in patients with active acromegaly disease