Giant prolactinomas (GPs) 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.
A single-center retrospective analysis of GPs (n=84), age-based (adults: 66 vs. pediatric: 18) and gender-based (males: 64 vs. females: 20) comparison was done.
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 vs. 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 (3865.5-12306) 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% vs.82.6%, p 0.001) and central hypocortisolism (5.6% vs.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% vs. 71.2%, p 0.04) was higher in the pediatric age group, with DA-induced (first-line) normoprolactinemia observed in 66.7% of them.
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.

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