Kawngwoo Park1, Kwang Hyon Park2, Hye Ran Park3, Jae Meen Lee4, Yong Hwy Kim5, Dong Young Kim6, Tae Bin Won6, Sung Hye Kong7, Jung Hee Kim7, Chan Soo Shin7, Sun Ha Paek8. 1. Department of Neurosurgery, Gachon University Gil Medical Center, Incheon, Korea. 2. Department of Neurosurgery, Chungnam National University Hospital, Daejeon, Korea. 3. Department of Neurosurgery, Soonchunhyang University Seoul Hospital, Seoul, Korea. 4. Department of Neurosurgery, Pusan National University Hospital, Busan, Korea. 5. Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea. 6. Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea. 7. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. 8. Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea. paeksh@snu.ac.kr.
Abstract
BACKGROUND: Although long-term dopamine agonist (DA) therapy is recommended as a first-line treatment for prolactinoma, some patients may prefer surgical treatment because of the potential adverse effects of long-term medication, or the desire to become pregnant. This study aimed to determine whether surgical treatment of prolactinomas could be an alternative to DA therapy. METHODS: In this retrospective study, 96 consecutive patients (74 female, 22 male) underwent primary pituitary surgery without long-term DA treatment for prolactinomas at a single institution from 1990 to 2010. All patients underwent primary surgical treatment in the microscopic transsphenoidal approach (TSA). RESULTS: The median age and median follow-up period were 31 (16-73) years and 139.1 (12.2-319.6) months, respectively. An initial overall remission was accomplished in 47.9% (46 of 96 patients, 33 macroadenomas, and 13 microadenomas) of patients. DA dose reduction was achieved in all patients after TSA. A better remission rate was independently predicted by lower diagnostic prolactin levels and by a greater extent of surgical resection. Overall remission at the last follow-up was 33.3%, and the overall recurrence rate was 30.4%. The permanent complication rate was 3.1%, and there was no mortality. CONCLUSION: TSA can be considered a safe and potentially curative treatment for selective microprolactinomas as an alternative to treatment with a long-term DA.
BACKGROUND: Although long-term dopamine agonist (DA) therapy is recommended as a first-line treatment for prolactinoma, some patients may prefer surgical treatment because of the potential adverse effects of long-term medication, or the desire to become pregnant. This study aimed to determine whether surgical treatment of prolactinomas could be an alternative to DA therapy. METHODS: In this retrospective study, 96 consecutive patients (74 female, 22 male) underwent primary pituitary surgery without long-term DA treatment for prolactinomas at a single institution from 1990 to 2010. All patients underwent primary surgical treatment in the microscopic transsphenoidal approach (TSA). RESULTS: The median age and median follow-up period were 31 (16-73) years and 139.1 (12.2-319.6) months, respectively. An initial overall remission was accomplished in 47.9% (46 of 96 patients, 33 macroadenomas, and 13 microadenomas) of patients. DA dose reduction was achieved in all patients after TSA. A better remission rate was independently predicted by lower diagnostic prolactin levels and by a greater extent of surgical resection. Overall remission at the last follow-up was 33.3%, and the overall recurrence rate was 30.4%. The permanent complication rate was 3.1%, and there was no mortality. CONCLUSION:TSA can be considered a safe and potentially curative treatment for selective microprolactinomas as an alternative to treatment with a long-term DA.
Authors: W A Bashari; M van der Meulen; J MacFarlane; D Gillett; R Senanayake; L Serban; A S Powlson; A M Brooke; D J Scoffings; J Jones; D G O'Donovan; J Tysome; T Santarius; N Donnelly; I Boros; F Aigbirhio; S Jefferies; H K Cheow; I A Mendichovszky; A G Kolias; R Mannion; O Koulouri; M Gurnell Journal: Pituitary Date: 2022-05-24 Impact factor: 3.599
Authors: Leontine E H Bakker; Marco J T Verstegen; Wouter R van Furth; Lenka M Pereira Arias Bouda; Eidrees Ghariq; Berit M Verbist; Pieter J Schutte; Waiel A Bashari; Mark C Kruit; Alberto M Pereira; Mark Gurnell; Nienke R Biermasz Journal: Pituitary Date: 2022-05-26 Impact factor: 3.599