Giant prolactinoma in Asian-Indians: A single-center experience from Western India

Purpose. - Giant prolactinomas (GP) are rare tumors accounting for 4.3% of prolactinomas, with paucity of literature from India. We aim to describe clinical, biochemical, radiological, and treatment outcomes in a large series of Asian-Indian patients with GP.Methods. - A single-center retrospective analysis of GPs (n = 84), age-based (adults: 66 versus pediatric: 18) and gender-based (males: 64 versus females: 20) comparison was done.Results. - The mean age at presentation was 34.1 +/- 13 years, and 64 (76.2%) were males. Males were younger at presentation (32.1 +/- 12.2 versus 40.1 +/- 13.8 years, P: 0.01). The majority presented with mass-effect-related manifestations (visual disturbances: 91.6%, headache: 84.5%) and/or hypogonadism (98.7%). At baseline, largest tumor dimension was 5.3 +/- 1.0 cm, and serum prolactin was 8343 (3865.5-12,306) ng/mL; most (94.6%) had gonadal axis involvement. Dopamine-agonist (DA) as first-line therapy (45/67, 67.2%) achieved normoprolactinemia (maximum cabergoline dose: 2.0 +/- 1.2 mg/week) in 36/45 (80%) and tumor response (>= 50% reduction) in 36/37 (97.3%) patients at the last follow-up (median duration: 33 [14.5-53.5] months). Notably, gonadal axis recovery was poor (6/30, 20%) despite normoprolactinemia post-DA monotherapy. At latest follow-up, secondary hypothyroidism (32.5% versus 82.6%, P: 0.001) and central hypocortisolism (5.6% versus 42.9%, P: 0.007) were less frequent in DA monotherapy (n = 43) than in multimodal therapy group (n = 23). The proportion of males (94.4% versus 71.2%, P: 0.04) was higher in the pediatric age group, with DA-induced (first-line) normoprolactinemia observed in 66.7% of them.Conclusion. - GP has male predominance, DA as first-line therapy normalized prolactin in four-fifths of patients with better preservation of HPT and HPA axes in patients with DA monotherapy. (c) 2023 Elsevier Masson SAS. All rights reserved.