Or Cohen-Inbar1, Zhiyuan Xu2, David Schlesinger2, Mary Lee Vance2,3, Jason P Sheehan4. 1. Department of Neurological Surgery, University of Virginia, Charlottesville, VA, 22908, USA. orcoheni@tx.technion.ac.il. 2. Department of Neurological Surgery, University of Virginia, Charlottesville, VA, 22908, USA. 3. Department of Medicine, University of Virginia, Charlottesville, VA, USA. 4. Department of Neurological Surgery, University of Virginia, Charlottesville, VA, 22908, USA. jsheehan@virginia.edu.
Abstract
INTRODUCTION: Prolactinomas are the most common functioning pituitary adenomas. Dopamine agonists (DA) are generally very effective in treating prolactinomas by inducing tumor volume regression and endocrine remission. A minority of patients do not respond to DA or are intolerant because of side-effects. Microsurgical resection when possible is the next treatment option, but cavernous sinus, dural, or bone involvement may not allow for complete resection. OBJECTIVE: We reviewed the outcome of patients with medically and surgically refractory prolactinomas treated with Gamma Knife radiosurgery (GKRS) during a 22 years follow-up period. METHODS: We reviewed the patient database at the University of Virginia Gamma Knife center during a 25-year period (1989-2014), identifying 38 patients having neurosurgical, radiological and endocrine follow-up. RESULTS: Median age at GKRS treatment was 43 years. Median follow-up was 42.3 months (range 6-207.9). 55.3 % (n = 21) were taking a dopamine agonist at time of GKRS. 63.2 % (n = 24) had cavernous sinus tumor invasion. Endocrine remission (normal serum prolactin off of a dopamine agonist) was achieved in 50 % (n = 19). GKRS induced hypopituitarism occurred in 30.3 % (n = 10). Cavernous sinus involvement was shown to be a significant negative prognosticator of endocrine remission. Taking a dopamine agonist drug at the time of GKRS showed a tendency to decrease the probability for endocrine remission. CONCLUSION: GKRS for refractory prolactinomas can lead to endocrine remission in many patients. Hypopituitarism is the most common side effect of GKRS.
INTRODUCTION:Prolactinomas are the most common functioning pituitary adenomas. Dopamine agonists (DA) are generally very effective in treating prolactinomas by inducing tumor volume regression and endocrine remission. A minority of patients do not respond to DA or are intolerant because of side-effects. Microsurgical resection when possible is the next treatment option, but cavernous sinus, dural, or bone involvement may not allow for complete resection. OBJECTIVE: We reviewed the outcome of patients with medically and surgically refractory prolactinomas treated with Gamma Knife radiosurgery (GKRS) during a 22 years follow-up period. METHODS: We reviewed the patient database at the University of Virginia Gamma Knife center during a 25-year period (1989-2014), identifying 38 patients having neurosurgical, radiological and endocrine follow-up. RESULTS: Median age at GKRS treatment was 43 years. Median follow-up was 42.3 months (range 6-207.9). 55.3 % (n = 21) were taking a dopamine agonist at time of GKRS. 63.2 % (n = 24) had cavernous sinus tumor invasion. Endocrine remission (normal serum prolactin off of a dopamine agonist) was achieved in 50 % (n = 19). GKRS induced hypopituitarism occurred in 30.3 % (n = 10). Cavernous sinus involvement was shown to be a significant negative prognosticator of endocrine remission. Taking a dopamine agonist drug at the time of GKRS showed a tendency to decrease the probability for endocrine remission. CONCLUSION: GKRS for refractory prolactinomas can lead to endocrine remission in many patients. Hypopituitarism is the most common side effect of GKRS.
Authors: Nader Pouratian; Jason Sheehan; Jay Jagannathan; Edward R Laws; Ladislau Steiner; Mary L Vance Journal: Neurosurgery Date: 2006-08 Impact factor: 4.654
Authors: Renato Cozzi; Maria Rosaria Ambrosio; Roberto Attanasio; Claudia Battista; Alessandro Bozzao; Marco Caputo; Enrica Ciccarelli; Laura De Marinis; Ernesto De Menis; Marco Faustini Fustini; Franco Grimaldi; Andrea Lania; Giovanni Lasio; Francesco Logoluso; Marco Losa; Pietro Maffei; Davide Milani; Maurizio Poggi; Michele Zini; Laurence Katznelson; Anton Luger; Catalina Poiana Journal: Eur J Endocrinol Date: 2022-02-03 Impact factor: 6.664