Knosp and Hardy Grading Systems are Useful in Predicting Persistence of Male Hypogonadism in Prolactinomas Following Prolactin Normalization
Yıl: 2020 Cilt: 24 Sayı: 4 Sayfa Aralığı: 284 - 292 Metin Dili: İngilizce DOI: 10.25179/tjem.2020-77688 İndeks Tarihi: 05-05-2021
Knosp and Hardy Grading Systems are Useful in Predicting Persistence of Male Hypogonadism in Prolactinomas Following Prolactin Normalization
Öz: Objective: Despite serum prolactin normalization and tumorshrinkage being obtained using dopamine agonist treatment,hypogonadism may persist in several men with prolactinomas.In this study, we evaluated the effects of tumor magnetic resonance imaging features on the persistence of hypogonadismamong normoprolactinemic men with prolactinomas objectivelyusing Knosp and Hardy grading systems. Material and Methods: The patients with prolactinomas who achieved serum prolactin normalization using cabergoline therapy were evaluated,respectively. The extent of tumor growth was evaluated on thebasis of Knosp and Hardy grading systems both at diagnosis andsix months of medical therapy with serum prolactin normalization. Results: A total of 28 cases (18 macro- and 10 microprolactinomas) were included. After six months of treatment withcabergoline, all microprolactinoma patients with hypogonadismat baseline showed recovery (3, 100%). Moreover, nine of 14macroprolactinoma patients with hypogonadism at inclusion recovered at the end (group 1), and five did not (group 2). Baseline Knosp grades and Hardy numbers did not differ betweengroups. However, higher Knosp grades and Hardy numbers wereobserved in patients who consistently had low serum testosterone in the sixth month (group 2) (p=0.01, p=0.02, respectively). All patients in group 2 had invasive tumors (Hardynumber III-IV) both at inclusion and the sixth month accordingto this classification. Conclusion: We demonstrated that macroprolactinomas with persistent hypogonadism despite serumprolactin normalization more commonly showed cavernous sinusinvasion and sellar destruction. We proposed that Knosp andHardy grading systems are useful in predicting the persistenceof male hypogonadism in prolactinomas following prolactin normalization.
Anahtar Kelime: Knosp ve Hardy Sınıflamaları, Prolaktinoması Olan Erkek Hastalarda Prolaktin Normalizasyonunu Takiben Hipogonadizminin Kalıcılığını Öngörmede Yararlıdır
Öz: Amaç: Prolaktinoması olan erkek hastalarda, dopamin agonistleri ile tedavi sonrası serum prolaktin normalizasyonu ve tümör küçülmesi sağlanmasına rağmen hipogonadizm devam edebilir. Bu çalışmada, normoprolaktinemik erkek prolaktinoma hastalarında, Knosp ve Hardy sınıflamalarını kullanarak tümörün manyetik rezonans görüntüleme özelliklerinin, kalıcı hipogonadizm gelişimi üzerine etkisini objektif olarak değerlendiridik. Gereç ve Yöntemler: Kabergolin tedavisi ile serum prolaktin normalizasyonu sağlanan prolaktinoma hastaları retrospektif olarak değerlendirildi. Hem tanı anında hem de medikal tedavi ile serum prolaktin normalizasyonunun sağlandığı altıncı ayda tümör büyümesinin derecesi Knosp ve Hardy sınıflamaları kullanılarak değerlendirildi. Bulgular: Yirmi sekiz olgu (18 makro ve 10 mikroprolaktinoma) dâhil edildi. Altı aylık kabergolin tedavisi ile başlangıçta hipogonadizmi olan bütün mikroprolaktinoma olgularında (3, %100) hipogonadizm düzeldi. Başlangıçta hipogonadizmi olan 14 makroprolaktinoma olgusunun 9’unda hipogonadizm düzelirken (Grup 1), 5 tanesinde hipogonadizm devem etti (Grup 2). Tanı anındaki Knosp ve Hardy skorları gruplar arasında farklılık göstermedi. Bununla birlikte, altıncı ayda düşük serum testosteronu olanlarda Knosp ve Hardy skorları daha yüksek olarak bulundu (Grup 2) (sırasıyla p=0,01, p=0,02). Bu sınıflamaya göre Grup 2’deki tüm hastaların hem tanı anında hem de altıncı ayda invaziv tümörleri (Hardy III-IV) vardı. Sonuç: Serum prolaktin normalizasyonuna rağmen hipogonadizmi düzelmeyen makroprolaktinoma olgularında, kavernöz sinüs invazyonu ve sellar destrüksiyonun daha sık olduğunu gösterdik. Prolaktnoması olan hastalarda, prolaktin normalizasyonunu takiben erkek hipogonadizminin kalıcılığını öngörmede Knosp ve Hardy sınıflamalarının yardımcı olabileceğini düşünmekteyiz.
Anahtar Kelime: Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
- 1. Fernandez A, Karavitaki N, Wass JA. Prevalence of pituitary adenomas: a community-based, cross-sectional study in Banbury (Oxfordshire, UK). Clin Endocrinol (Oxf). 2010;72:377-382. [Crossref] [PubMed]
- 2. Melmed S, Kleinberg D. Pituitary masses and tumors. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology (13th ed). Philadelphia; Elsevier; 2016;260-266. [Crossref]
- 3. Gillam MP, Molitch ME. Prolactinoma. In: Melmed S, ed. The Pituitary (3rd ed). San Diego; Elsevier; 2011;475-531. [Crossref]
- 4. Liu W, Zahr RS, McCartney S, Cetas JS, Dogan A, Fleseriu M. Clinical outcomes in male patients with lactotroph adenomas who required pituitary surgery: a retrospective single center study. Pituitary. 2018;21:454-462. [Crossref] [PubMed]
- 5. Andereggen L, Frey J, Andres RH, El-Koussy M, Beck J, Seiler RW, Christ E. Long-term follow-up of primary medical versus surgical treatment of prolactinomas in men: effects on hyperprolactinemia, hypogonadism, and bone health. World Neurosurg. 2017;97:595-602. [Crossref] [PubMed]
- 6. Nishioka H, Inoshita N. New WHO classification of pituitary adenomas (4th edition): assessment of pituitary transcription factors and the prognostic histological factors. Brain Tumor Pathol. 2018;35:57-61. [Crossref] [PubMed]
- 7. Davies BM, Carr E, Soh C, Gnanalingham KK. Assessing size of pituitary adenomas: a comparison of qualitative and quantitative methods on MR. Acta Neurochir (Wien). 2016;158:677-683. [Crossref] [PubMed] [PMC]
- 8. Knosp E, Steiner E, Kitz K, Matula C. Pituitary adenomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings. Neurosurgery. 1993;33:610-617. [Crossref] [PubMed]
- 9. Hardy J, Somma M. Surgical treatment by transsphenoidal microsurgical removal of the pituitary adenoma. In: Colins W, Tindall G, eds. Clinical Management of Pituitary Disorders. 1st ed. New York; Raven;1979;209-217. [Crossref]
- 10. Di Ieva A, Rotondo F, Syro LV, Cusimano MD, Kovacs K. Aggressive pituitary adenomas--diagnosis and emerging treatments. Nat Rev Endocrinol. 2014;10:423-435. [Crossref] [PubMed]
- 11.Melmed S, Casanueva FF, Hoffman AR, Kleinberg DL, Montori VM, Schlechte JA, Wass JA; Endocrine Society. Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96:273- 288. [Crossref] [PubMed]
- 12.Beshyah SA, Sherif IH, Chentli F, Hamrahian A, Khalil AB, Raef H, El-Fikki M, Jambart S. Management of prolactinomas: a survey of physicians from the Middle East and North Africa. Pituitary. 2017;20:231-240. [Crossref] [PubMed]
- 13. Dogansen SC, Selcukbiricik OS, Tanrikulu S, Yarman S. Withdrawal of dopamine agonist therapy in prolactinomas: In which patients and when? Pituitary. 2016;19:303-310. [Crossref] [PubMed]
- 14. Pinzone JJ, Katznelson L, Danila DC, Pauler DK, Miller CS, Klibanski A. Primary medical therapy of micro- and macroprolactinomas in men. J Clin Endocrinol Metab. 2000;85:3053-3057. [Crossref] [PubMed]
- 15.Berezin M, Shimon I, Hadani M. Prolactinoma in 53 men: clinical characteristics and modes of treatment (male prolactinoma). J Endocrinol Invest. 1995;18:436-441. [Crossref] [PubMed]
- 16.Andrysiak-Mamos E, Kaźmierczyk-Puchalska A, Zochowska E, Sowińska-Przepiera E, Sagan L, Kojder I, Syrenicz A. Evaluaton of therapy with cabergoline in men with macroprolactinoa. Pomeranian J Life Sci. 2015;61(3):263-9. [Crossref] [PubMed]
- 17. Tirosh A, Benbassat C, Lifshitz A, Shimon I. Hypopituitarism patterns and prevalence among men with macroprolactinomas. Pituitary. 2015;18:108- 115. [Crossref] [PubMed]
- 18. Iglesias P, Bernal C, Villabona C, Castro JC, Arrieta F, Díez JJ. Prolactinomas in men: a multicentre and retrospective analysis of treatment outcome. Clin Endocrinol (Oxf). 2012;77:281-287. [Crossref] [PubMed]
- 19.Sibal L, Ugwu P, Kendall-Taylor P, Ball SG, James RA, Pearce SH, Hall K, Quinton R. Medical therapy of macroprolactinomas in males: I. Prevalence of hypopituitarism at diagnosis. II. Proportion of cases exhibiting recovery of pituitary function. Pituitary. 2002;5:243-246. [Crossref] [PubMed]
- 20.Colao A, Vitale G, Cappabianca P, Briganti F, Ciccarelli A, De Rosa M, Zarrilli S, Lombardi G. Outcome of cabergoline treatment in men with prolactinoma: effects of a 24-month treatment on prolactin levels, tumor mass, recovery of pituitary function, and semen analysis. J Clin Endocrinol Metab. 2004;89:1704-1711. [Crossref] [PubMed]
- 21.Shimon I, Benbassat C. Male prolactinomas presenting with normal testosterone levels. Pituitary. 2014;17:246-250. [Crossref] [PubMed]
- 22.Karavitaki N, Dobrescu R, Byrne JV, Grossman AB, Wass JA. Does hypopituitarism recover when macroprolactinomas are treated with cabergoline? Clin Endocrinol (Oxf). 2013;79:217-223. [Crossref] [PubMed]
- 23.Ciccarelli A, Guerra E, De Rosa M, Milone F, Zarrilli S, Lombardi G, Colao A. PRL secreting adenomas in male patients. Pituitary. 2005;8:39-42. [Crossref] [PubMed]
- 24.Walia R, Bhansali A, Dutta P, Khandelwal N, Sialy R, Bhadada S. Recovery pattern of hypothalamo-pituitary-testicular axis in patients with macroprolactinomas after treatment with cabergoline. Indian J Med Res. 2011;134:314-319. [PubMed] [PMC]
- 25.Arafah BM, Prunty D, Ybarra J, Hlavin ML, Selman WR. The dominant role of increased intrasellar pressure in the pathogenesis of hypopituitarism, hyperprolactinemia, and headaches in patients with pituitary adenomas. J Clin Endocrinol Metab. 2000;85:1789-1793. [Crossref] [PubMed]
- 26. Tirosh A, Benbassat C, Shimon I. Short-term decline in prolactin concentrations can predict future prolactin normalization, tumor shrinkage, and time to remission in men with macroprolactinomas. Endocr Pract. 2015;21:1240-1247. [Crossref] [PubMed]
- 27.Shimon I, Benbassat C, Hadani M. Effectiveness of long-term cabergoline treatment for giant prolactinoma: study of 12 men. Eur J Endocrinol. 2007;156:225-231. [Crossref] [PubMed]
| APA | ŞİMŞEK BAĞIR G, gunesli a, Eksi Haydardedeoglu F, bakiner o, alkan o, Ertorer M (2020). Knosp and Hardy Grading Systems are Useful in Predicting Persistence of Male Hypogonadism in Prolactinomas Following Prolactin Normalization. , 284 - 292. 10.25179/tjem.2020-77688 |
| Chicago | ŞİMŞEK BAĞIR GÜLAY,gunesli aylin,Eksi Haydardedeoglu Filiz,bakiner okan,alkan ozlem,Ertorer Melek Eda Knosp and Hardy Grading Systems are Useful in Predicting Persistence of Male Hypogonadism in Prolactinomas Following Prolactin Normalization. (2020): 284 - 292. 10.25179/tjem.2020-77688 |
| MLA | ŞİMŞEK BAĞIR GÜLAY,gunesli aylin,Eksi Haydardedeoglu Filiz,bakiner okan,alkan ozlem,Ertorer Melek Eda Knosp and Hardy Grading Systems are Useful in Predicting Persistence of Male Hypogonadism in Prolactinomas Following Prolactin Normalization. , 2020, ss.284 - 292. 10.25179/tjem.2020-77688 |
| AMA | ŞİMŞEK BAĞIR G,gunesli a,Eksi Haydardedeoglu F,bakiner o,alkan o,Ertorer M Knosp and Hardy Grading Systems are Useful in Predicting Persistence of Male Hypogonadism in Prolactinomas Following Prolactin Normalization. . 2020; 284 - 292. 10.25179/tjem.2020-77688 |
| Vancouver | ŞİMŞEK BAĞIR G,gunesli a,Eksi Haydardedeoglu F,bakiner o,alkan o,Ertorer M Knosp and Hardy Grading Systems are Useful in Predicting Persistence of Male Hypogonadism in Prolactinomas Following Prolactin Normalization. . 2020; 284 - 292. 10.25179/tjem.2020-77688 |
| IEEE | ŞİMŞEK BAĞIR G,gunesli a,Eksi Haydardedeoglu F,bakiner o,alkan o,Ertorer M "Knosp and Hardy Grading Systems are Useful in Predicting Persistence of Male Hypogonadism in Prolactinomas Following Prolactin Normalization." , ss.284 - 292, 2020. 10.25179/tjem.2020-77688 |
| ISNAD | ŞİMŞEK BAĞIR, GÜLAY vd. "Knosp and Hardy Grading Systems are Useful in Predicting Persistence of Male Hypogonadism in Prolactinomas Following Prolactin Normalization". (2020), 284-292. https://doi.org/10.25179/tjem.2020-77688 |
| APA | ŞİMŞEK BAĞIR G, gunesli a, Eksi Haydardedeoglu F, bakiner o, alkan o, Ertorer M (2020). Knosp and Hardy Grading Systems are Useful in Predicting Persistence of Male Hypogonadism in Prolactinomas Following Prolactin Normalization. Turkish Journal of Endocrinology and Metabolism, 24(4), 284 - 292. 10.25179/tjem.2020-77688 |
| Chicago | ŞİMŞEK BAĞIR GÜLAY,gunesli aylin,Eksi Haydardedeoglu Filiz,bakiner okan,alkan ozlem,Ertorer Melek Eda Knosp and Hardy Grading Systems are Useful in Predicting Persistence of Male Hypogonadism in Prolactinomas Following Prolactin Normalization. Turkish Journal of Endocrinology and Metabolism 24, no.4 (2020): 284 - 292. 10.25179/tjem.2020-77688 |
| MLA | ŞİMŞEK BAĞIR GÜLAY,gunesli aylin,Eksi Haydardedeoglu Filiz,bakiner okan,alkan ozlem,Ertorer Melek Eda Knosp and Hardy Grading Systems are Useful in Predicting Persistence of Male Hypogonadism in Prolactinomas Following Prolactin Normalization. Turkish Journal of Endocrinology and Metabolism, vol.24, no.4, 2020, ss.284 - 292. 10.25179/tjem.2020-77688 |
| AMA | ŞİMŞEK BAĞIR G,gunesli a,Eksi Haydardedeoglu F,bakiner o,alkan o,Ertorer M Knosp and Hardy Grading Systems are Useful in Predicting Persistence of Male Hypogonadism in Prolactinomas Following Prolactin Normalization. Turkish Journal of Endocrinology and Metabolism. 2020; 24(4): 284 - 292. 10.25179/tjem.2020-77688 |
| Vancouver | ŞİMŞEK BAĞIR G,gunesli a,Eksi Haydardedeoglu F,bakiner o,alkan o,Ertorer M Knosp and Hardy Grading Systems are Useful in Predicting Persistence of Male Hypogonadism in Prolactinomas Following Prolactin Normalization. Turkish Journal of Endocrinology and Metabolism. 2020; 24(4): 284 - 292. 10.25179/tjem.2020-77688 |
| IEEE | ŞİMŞEK BAĞIR G,gunesli a,Eksi Haydardedeoglu F,bakiner o,alkan o,Ertorer M "Knosp and Hardy Grading Systems are Useful in Predicting Persistence of Male Hypogonadism in Prolactinomas Following Prolactin Normalization." Turkish Journal of Endocrinology and Metabolism, 24, ss.284 - 292, 2020. 10.25179/tjem.2020-77688 |
| ISNAD | ŞİMŞEK BAĞIR, GÜLAY vd. "Knosp and Hardy Grading Systems are Useful in Predicting Persistence of Male Hypogonadism in Prolactinomas Following Prolactin Normalization". Turkish Journal of Endocrinology and Metabolism 24/4 (2020), 284-292. https://doi.org/10.25179/tjem.2020-77688 |
