Anastrozole as add-on therapy for cabergoline-resistant prolactin-secreting pituitary adenomas: real-life experience in male patients.
Anastrozole as add-on therapy for cabergoline-resistant prolactin-secreting pituitary adenomas: real-life experience in male patients.
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DOI：
10.1007/s11102-021-01165-0
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发表时间：
2021-12
期刊：
影响因子：
3.8
通讯作者：
Scaroni C
中科院分区：
文献类型：
--
作者：
Ceccato F;Lizzul L;Voltan G;Barbot M;Scaroni C
催乳素分泌腺瘤（PRLoma）可表现为较大的侵袭性肿瘤，伴有细胞增殖标记物增加。一线治疗方法是多巴胺激动剂（DA）治疗;然而，已报告DA耐药，尤其是男性患者。雌激素诱导催乳细胞复制和PRL分泌：在少数病例中描述了PRLoma患者使用抗雌激素治疗。我们报告了我们的经验，治疗与芳香化酶抑制剂阿那曲唑（ANA）作为添加治疗男性患者DA耐药PRLoma。我们描述了4例男性患者（诊断时年龄分别为26、38、29和19岁），患有PRLoma（中位直径26 mm，PRL 7730 μg/L）。就催乳素分泌和肿瘤尺寸缩小而言，他们对卡麦角林（CAB，> 2 mg/周）具有耐药性。ANA 1 mg/天添加到CAB的最大耐受剂量至少1年。在基线、CAB + ANA联合治疗6个月后以及之后每12个月进行一次磁共振检查。CAB + ANA后所有患者的PRL水平均下降（平均-70%，范围-44/-97%），其中一例患者的PRL水平恢复正常。所有病例的肿瘤大小均减小（平均-47%，范围-24.5/-68%）。未报告严重不良反应，在两例病例中观察到中度体重增加。在多巴胺激动剂治疗中加入芳香酶抑制剂（ANA）可改善催乳素水平的控制，并诱导肿瘤消退。
Prolactin-secreting adenoma (PRLoma) can present as large and invasive neoplasm, with increased markers of cellular proliferation. First-line approach is Dopamine Agonists (DAs) treatment; however, DA-resistance has been reported, especially in male patients. Estrogens induce lactotroph cell replication and PRL secretion: the use of anti-estrogen treatment in patients with PRLoma have been described in few cases. We reported our experience regarding treatment with the aromatase inhibitor anastrozole (ANA) as add-on therapy for male patients with DA resistant PRLoma. We describe four male patients (26, 38, 29 and 19 years old at diagnosis), with PRLoma (median diameter 26 mm, PRL 7730 μg/L). They were resistant to cabergoline (CAB, > 2 mg/week) in terms of PRL secretion and tumor size reduction. ANA 1 mg/day was added to the maximum tolerated dose of CAB for at least 1 year. Magnetic Resonance was performed at baseline, after 6 months of CAB + ANA combination and every 12 months afterward. PRL levels decreased in all patients after CAB + ANA (mean − 70%, range − 44/− 97%), achieving a normalization of PRL levels in one case. Tumor size decreased in all cases (mean − 47%, range − 24.5/− 68%). No severe adverse effects have been reported, a moderate weight gain has been observed in two cases. Addition of an aromatase inhibitor (ANA) to the dopamine agonist therapy improved the control of prolactin levels and induced tumour regression.
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