{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T19:15:35Z","timestamp":1789499735959,"version":"build-2803163510"},"reference-count":54,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2002,8]]},"abstract":"<jats:p content-type=\"fine-print\"><jats:italic>Object.<\/jats:italic> Giant prolactinomas are rare tumors whose treatment and outcome has only been addressed in isolated case reports. The authors document the long-term follow-up findings and clinical outcome in a group of patients with giant prolactinomas.<\/jats:p>\n<jats:p content-type=\"fine-print\"><jats:italic>Methods.<\/jats:italic> This study is a retrospective chart and clinical review of more than 2000 cases of pituitary tumors treated at the authors' institution, of which 10 met the criteria for inclusion (prolactin level &gt; 1000 ng\/ml, diameter &gt; 4 cm on neuroimaging studies, and clinical signs of hyperprolactinemia\/mass effect). The average follow-up duration was 6.7 years after initial treatment with either bromocriptine or transsphenoidal resection. In more than 90% of the patients in this series the disease was controlled by medical treatment with bromocriptine alone; the other 10% required early surgery via transsphenoidal resection. All patients had improvement in visual symptoms. All tumors had extrasellar components, five of which exhibited frank invasion of the cavernous sinus. Tumor volume on magnetic resonance imaging was decreased on average by 69%; this occurred at a faster rate and in larger amounts when treated with bromocriptine than has been reported in the literature for macroprolactinomas.<\/jats:p>\n<jats:p content-type=\"fine-print\"><jats:italic>Conclusions.<\/jats:italic> According to long-term follow-up findings, giant prolactinomas are exquisitely responsive to dopamine agonist therapy. In giant prolactinomas the prolactin level does not correlate with size. The main indication for early surgery is intratumoral hematoma, whereas our main indications for late surgery are cerebrospinal fluid leakage caused by medical treatment, or an increasing prolactin level despite medical therapy. Checking prolactin levels in suspicious sellar and\/or suprasellar lesions may be diagnostic and prevent unnecessary surgery.<\/jats:p>","DOI":"10.3171\/jns.2002.97.2.0299","type":"journal-article","created":{"date-parts":[[2009,5,13]],"date-time":"2009-05-13T17:45:03Z","timestamp":1242236703000},"page":"299-306","source":"Crossref","is-referenced-by-count":126,"title":["Giant prolactinomas: clinical management and long-term follow up"],"prefix":"10.3171","volume":"97","author":[{"given":"Raj K.","family":"Shrivastava","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc S.","family":"Arginteanu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wesley A.","family":"King","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kalmon D.","family":"Post","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"379","DOI":"10.1097\/00006123-198508000-00026","article-title":"Microprolactinoma and large prolactinoma: are they two different diseases.","volume":"17","author":"Al-Mefty","year":"1985"},{"key":"b2","series-title":"Pituitary","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1023\/A:1009931413106","article-title":"Invasive pituitary adenomas: significance of proliferation parameters.","volume":"2","author":"Amar","year":"1999"},{"key":"b3","series-title":"Contemp Neurosurg","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1097\/00029679-199517130-00001","article-title":"Prolactinomas: diagnosis and management.","volume":"17","author":"Arguello","year":"1995"},{"key":"b4","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"240","DOI":"10.3171\/jns.1950.7.3.0240","article-title":"The results of 300 pituitary adenoma operations (Prof. Herbert Olivecrona's series).","volume":"7","author":"Bakay","year":"1950"},{"key":"b5","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"913","DOI":"10.1097\/00006123-199804000-00126","article-title":"Giant pituitary prolactinoma with falsely low serum prolactin: the pitfall of the \u201chigh-dose hook effect\u201d: case report.","volume":"42","author":"Barkan","year":"1998"},{"key":"b6","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"554","DOI":"10.3171\/jns.1988.68.4.0554","article-title":"Management of prolactinomas associated with very high serum prolactin levels.","volume":"68","author":"Barrow","year":"1988"},{"key":"b7","series-title":"J Clin Endocrinol Metab","first-page":"275","article-title":"Treatment of macroprolactinomas with the long-acting and repeatable form of bromocriptine: a report of 29 cases.","volume":"75","author":"Beckers","year":"1992"},{"key":"b8","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"1153","DOI":"10.3171\/jns.1996.85.6.1153","article-title":"Symptoms of pituitary apoplexy rapidly reversed with bromocriptine. Case report.","volume":"85","author":"Brisman","year":"1996"},{"key":"b9","series-title":"J Clin Endocrinol Metab","doi-asserted-by":"publisher","first-page":"737","DOI":"10.1210\/jcem-53-4-737","article-title":"Size reduction of macroprolactinomas by bromocriptine or lisuride treatment.","volume":"53","author":"Chiodini","year":"1981"},{"key":"b10","series-title":"Ann Med","doi-asserted-by":"publisher","first-page":"452","DOI":"10.3109\/07853899809002486","article-title":"Treatment of prolactinomas.","volume":"30","author":"Colao","year":"1998"},{"key":"b11","series-title":"Br J Neurosurg","doi-asserted-by":"publisher","first-page":"51","DOI":"10.3109\/02688699409002393","article-title":"Prolactinomas in men masquerading as invasive skull base tumours.","volume":"8","author":"Cook","year":"1994"},{"key":"b12","series-title":"J Clin Endocrinol Metab","first-page":"2102","article-title":"Sex-related difference in the growth of prolactinomas: a clinical and proliferation marker study.","volume":"82","author":"Delgrange","year":"1997"},{"key":"b13","series-title":"Neurosurgery","first-page":"542","article-title":"Transcranial epidural approach to pituitary tumors extending beyond the sella.","volume":"41","author":"Dolenc","year":"1997"},{"key":"b14","series-title":"Neurosurg Rev","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1007\/BF01815444","article-title":"Present status of neurosurgery in the treatment of prolactinomas.","volume":"8","author":"Fahlbusch","year":"1985"},{"key":"b15","series-title":"J Clin Endocrinol Metab","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1210\/jcem.85.1.6329","article-title":"Long-term treatment of prolactin-secreting macroadenomas with pergolide.","volume":"85","author":"Freda","year":"2000"},{"key":"b16","series-title":"Acta Neurochir","doi-asserted-by":"publisher","first-page":"1042","DOI":"10.1007\/BF01412306","article-title":"Surgical management of giant pituitary tumours\u2014a review of 30 cases.","volume":"138","author":"Goel","year":"1996"},{"key":"b17","series-title":"Acta Neurochir","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1007\/BF01406303","article-title":"Characteristics of giant pituitary adenomas.","volume":"60","author":"Grote","year":"1982"},{"key":"b18","series-title":"Prog Neurol Surg","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1159\/000397693","article-title":"Trans-sphenoidal microsurgical removal of pituitary micro-adenoma.","volume":"6","author":"Hardy","year":"1975"},{"key":"b19","series-title":"Surg Neurol","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1016\/0090-3019(86)90114-X","article-title":"Long-term follow-up of large or invasive pituitary adenomas.","volume":"25","author":"Hashimoto","year":"1986"},{"key":"b20","series-title":"Acta Med Scand","first-page":"101","article-title":"Prolactinomas in men: clinical characteristics and the effect of bromocriptine treatment.","volume":"217","author":"Hulting","year":"1985"},{"key":"b21","series-title":"Surg Neurol","doi-asserted-by":"publisher","first-page":"280","DOI":"10.1016\/0090-3019(92)90153-E","article-title":"Giant basal prolactinoma extending into the nasal cavity.","volume":"37","author":"Iwai","year":"1992"},{"key":"b22","series-title":"J Endocrinol Invest","doi-asserted-by":"publisher","first-page":"472","DOI":"10.1007\/BF03349893","article-title":"Treatment with long acting repeatable bromocriptine (Parlodel-LAR*) in patients with macroprolactinomas: long-term study in 29 patients.","volume":"19","author":"Jamrozik","year":"1996"},{"key":"b23","series-title":"J Neurol Neurosurg Psychiatry","first-page":"633","article-title":"Chromophobe pituitary adenomata the size of the suprasellar portion in relation to the safety of the operation.","volume":"32","author":"Jefferson","year":"1969"},{"key":"b24","series-title":"Am J Med","first-page":"868","article-title":"Hyperprolactinemia. Long-term effects of bromocriptine.","volume":"75","author":"Johnston","year":"1983"},{"key":"b25","series-title":"Acta Neurochir","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1007\/BF01402614","article-title":"A simple method of estimating the size of large pituitary adenomas.","volume":"107","author":"Jones","year":"1990"},{"key":"b26","series-title":"Skull Base Surg","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1055\/s-2008-1058909","article-title":"Microsurgical management of giant pituitary tumors.","volume":"6","author":"King","year":"1996"},{"key":"b27","series-title":"Pituitary Disorders: Comprehensive Management.","first-page":"287","article-title":"Giant invasive pituitary adenomas","author":"Krisht","year":"1999"},{"key":"b28","series-title":"Contemp Neurosurg","first-page":"1","article-title":"Giant invasive pituitary adenomas: management plan.","volume":"21","author":"Krisht","year":"1999"},{"key":"b29","series-title":"Lancet","first-page":"657","article-title":"Bromocriptine: does it jeopardize the result of later surgery for prolactinomas?","volume":"2","author":"Landolt","year":"1982"},{"key":"b30","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"656","DOI":"10.1056\/NEJM198509123131103","article-title":"Low doses of dopamine agonists in the long-term treatment of macroprolactinomas.","volume":"313","author":"Liuzzi","year":"1985"},{"key":"b31","series-title":"Neuroradiology","doi-asserted-by":"publisher","first-page":"651","DOI":"10.1007\/s002340050657","article-title":"Imaging of giant pituitary adenomas.","volume":"40","author":"Majos","year":"1998"},{"key":"b32","series-title":"Can J Neurol Sci","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1017\/S0317167100030055","article-title":"Surgical management of giant pituitary adenomas.","volume":"17","author":"Mohr","year":"1990"},{"key":"b33","series-title":"J Clin Endocrinol Metab","doi-asserted-by":"publisher","first-page":"698","DOI":"10.1210\/jcem-60-4-698","article-title":"Bromocriptine as primary therapy for prolactin-secreting macroadenomas: results of a prospective multicenter study.","volume":"60","author":"Molitch","year":"1985"},{"key":"b34","series-title":"Am J Med","doi-asserted-by":"publisher","first-page":"995","DOI":"10.1016\/0002-9343(87)90668-1","article-title":"Giant invasive prolactinomas.","volume":"83","author":"Murphy","year":"1987"},{"key":"b35","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"634","DOI":"10.1227\/00006123-198312000-00002","article-title":"Factors in predicting outcome from operation in patients with prolactin-secreting pituitary adenomas.","volume":"13","author":"Nelson","year":"1983"},{"key":"b36","series-title":"Surg Neurol","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1016\/S0090-3019(00)00171-3","article-title":"Pituitary adenomas: results of 684 surgically treated patients and review of the literature.","volume":"53","author":"Oruckaptan","year":"2000"},{"key":"b37","series-title":"J Comput Assist Tomogr","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1097\/00004728-198402000-00027","article-title":"Rapid size reduction of giant prolactinoma following medical treatment.","volume":"8","author":"Perani","year":"1984"},{"key":"b38","series-title":"Cancer","doi-asserted-by":"publisher","first-page":"804","DOI":"10.1002\/(SICI)1097-0142(19970215)79:4<804::AID-CNCR18>3.0.CO;2-3","article-title":"Pituitary carcinoma: a clinicopathologic study of 15 cases.","volume":"79","author":"Pernicone","year":"1997"},{"key":"b39","series-title":"Neurosurg Rev","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1007\/BF01815445","article-title":"Giant pituitary adenomas.","volume":"8","author":"Pia","year":"1985"},{"key":"b40","series-title":"JAMA","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1001\/jama.1979.03300020028020","article-title":"Selective transsphenoidal adenomectomy in women with galactorrhea-amenorrhea.","volume":"242","author":"Post","year":"1979"},{"key":"b41","series-title":"JAMA","doi-asserted-by":"publisher","first-page":"921","DOI":"10.1001\/jama.1984.03350070039020","article-title":"Long-term follow-up of transsphenoidal selective adenomectomy for prolactinoma.","volume":"252","author":"Rodman","year":"1984"},{"key":"b42","series-title":"Endocr Rev","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1210\/edrv-1-3-295","article-title":"Prolactin-secreting pituitary tumors in amenorrheic women: a comprehensive study.","volume":"1","author":"Schlechte","year":"1980"},{"key":"b43","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"402","DOI":"10.3171\/jns.1986.64.3.0402","article-title":"The occurrence of dural invasion in pituitary adenomas.","volume":"64","author":"Selman","year":"1986"},{"key":"b44","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"280","DOI":"10.1056\/NEJM198308043090505","article-title":"Recurrence of hyperprolactinemia after selective transsphenoidal adenomectomy in women with prolactinoma.","volume":"309","author":"Serri","year":"1983"},{"key":"b45","series-title":"Ann Intern Med","doi-asserted-by":"publisher","first-page":"472","DOI":"10.7326\/0003-4819-129-6-199809150-00009","article-title":"Management of pituitary tumors.","volume":"129","author":"Shimon","year":"1998"},{"key":"b46","series-title":"Horm Res","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1159\/000180318","article-title":"Extrasellar prolactinomas: successful management of 24 patients using bromocriptine.","volume":"23","author":"Sieck","year":"1986"},{"key":"b47","series-title":"J Neurol Neurosurg Psychiatry","doi-asserted-by":"publisher","first-page":"973","DOI":"10.1136\/jnnp.42.11.973","article-title":"Surgical treatment of giant pituitary adenomas.","volume":"42","author":"Symon","year":"1979"},{"key":"b48","series-title":"J Neuroophthalmol","first-page":"252","article-title":"Chiasmal herniation as a complication of bromocriptine therapy.","volume":"16","author":"Taxel","year":"1996"},{"key":"b49","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1097\/00006123-199902000-00006","article-title":"Transsphenoidal microsurgical therapy of prolactinomas: initial outcomes and long-term results.","volume":"44","author":"Tyrrell","year":"1999"},{"key":"b50","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1227\/00006123-198502000-00028","article-title":"Role of defective dopaminergic inhibition of prolactin secretion in the pathogenesis of prolactinoma.","volume":"16","author":"Vertosick","year":"1985"},{"key":"b51","series-title":"Clin Endocrinol","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1111\/j.1365-2265.1987.tb01163.x","article-title":"Long-term treatment of hyperprolactinaemia with bromocriptine: effect of drug withdrawal.","volume":"27","author":"Wang","year":"1987"},{"key":"b52","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"814","DOI":"10.3171\/jns.1984.61.5.0814","article-title":"A decade of pituitary microsurgery. The Herbert Olivecrona lecture.","volume":"61","author":"Wilson","year":"1984"},{"key":"b53","series-title":"Clin Neurosurg","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1093\/neurosurgery\/21.CN_suppl_1.8","article-title":"Pituitary adenomas: factors in treatment.","volume":"21","author":"Wirth","year":"1974"},{"key":"b54","series-title":"Horm Res","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1159\/000179381","article-title":"Prolactinomas and optic nerve compression: disappearance of suprasellar extension and visual recovery after two weeks bromocriptine treatment.","volume":"14","author":"Woodhouse","year":"1981"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/97\/2\/article-p299.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/97\/2\/article-p299.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/97\/2\/article-p299.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,20]],"date-time":"2023-03-20T01:20:32Z","timestamp":1679275232000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/97\/2\/article-p299.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2002,8]]},"references-count":54,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.3171\/jns.2002.97.2.0299","relation":{},"ISSN":["0022-3085"],"issn-type":[{"value":"0022-3085","type":"print"}],"subject":[],"published":{"date-parts":[[2002,8]]}}}