Efficacy and Safety of Endoscopic Transsphenoidal Resection for Prolactinoma: A Retrospective Multicenter Case-series

Zandbergen, Ingrid Marijke; Huntoon, Kristin Michelle; White, Timothy G.; Bakker, Leontine Erica Henriëtte; Verstegen, Marco Johanna Theodorus; Ghalib, Luma Mudhafar; van Furth, Wouter Ralph; Pelsma, Iris Catharina Maria; Dehdashti, Amir R.; Biermasz, Nienke Ruurdje; Prevedello, Daniel M.

doi:10.1016/j.arcmed.2023.102919

Cited by 3 publications

(1 citation statement)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In particular, there are no studies reporting remission rates after discontinuation of DA therapy in prolactinoma patients with cavernous sinus invasion [32]. Surgical remission rates in patients with cavernous sinus invasion documented in the literature are consistently low and consistent with those observed at our center [37][38][39]. Consequently, surgical intervention does not confer a significant benefit in the treatment of this patient group.…”

Section: Accepted Manuscriptmentioning

confidence: 56%

Role of Medical and Surgical Treatment in Management of the Patients With Prolactinoma: A Single-Center Experience

Zulfaliyeva,

Demir,

Cetintas

et al. 2024

Exp Clin Endocrinol Diabetes

View full text Add to dashboard Cite

Background: Current guidelines recommend dopamine agonists (DA) as the primary therapeutic approach for prolactinomas; however, emerging evidence suggests that surgical intervention can also yield favorable outcomes. Objective: To comprehensively evaluate prolactinoma patients undergoing surgical and medical treatments at our pituitary center. Methods: Retrospective review of medical records from prolactinoma patients treated between 2015 and 2022 was performed. The study focused on treatment outcomes and remission rates while investigating factors influencing the success of both treatment modalities in achieving remission. Results: A total of 301 prolactinoma patients were included, of whom 199 were women. Among them, 235 were managed medically, while 66 underwent surgical intervention. The overall remission rates of patients treated with medical and surgery were similar at the final examination (Respectively 82.9% and 81.8%, p=0.114). Factors associated with remission in both treatment modalities included female sex, low initial prolactin levels, small adenoma size, and absence of cavernous invasion. Surgical treatment demonstrated a higher rate of drug-free remission compared to DA treatment for microadenomas, and macroadenomas without cavernous invasion. In cases with cavernous invasion, standalone surgical treatment yielded a low rate of drug-free remission (7.7%); however, when combined with DA therapy post-surgery, remission rates increased to 66.7%. Conclusion: Medical treatment with DAs remains the preferred option for macroadenomas with cavernous sinus invasion, and giant adenomas, with surgery reserved for selected cases to address complications. Conversely, surgery emerges as the most effective modality for achieving remission in patients with microadenomas, and macroadenomas confined to the sella. The recommendation of DAs as first-line therapy for all patients has been withdrawn in the current guidelines and individual treatment approaches based on tumor characteristics are emphasized. Our results support this approach.

show abstract

Section: Accepted Manuscriptmentioning

confidence: 56%

Role of Medical and Surgical Treatment in Management of the Patients With Prolactinoma: A Single-Center Experience

Zulfaliyeva,

Demir,

Cetintas

et al. 2024

Exp Clin Endocrinol Diabetes

View full text Add to dashboard Cite

show abstract

Prolactinoma: navigating the dual challenge of side effects and treatment strategies - a comprehensive narrative review

Yogeeta,

Rauf,

Devi

et al. 2024

Annals of Medicine &Amp; Surgery

View full text Add to dashboard Cite

This narrative review provides a succinct exploration of Prolactinoma, the most common pituitary adenoma, focusing on its epidemiology, clinical manifestations, and therapeutic interventions. Beginning with an overview of its prevalence and aetiology, the review delves into the gender distribution and familial associations of Prolactinoma. Clinical presentations, including endocrine disruptions, reproductive health issues, and metabolic disturbances, are examined, emphasizing their impact on hormonal regulation and cardiovascular health. The narrative then navigates through pharmacological treatments, surgical interventions, and radiation therapy, highlighting their efficacy, side effects, and long-term management challenges. Strategies to mitigate side effects and optimize treatment outcomes are discussed, emphasizing the importance of multidisciplinary collaboration in prolactinoma management. This review is a concise yet comprehensive resource for healthcare professionals and researchers, providing insights into Prolactinoma’s clinical complexities and therapeutic nuances to guide optimal patient care strategies.

show abstract

The Changing Treatment Paradigm for Prolactinoma—A Prospective Series of 100 Consecutive Neurosurgical Cases

van Trigt,

Bakker,

Pelsma

et al. 2024

The Journal of Clinical Endocrinology &Amp; Metabolism

View full text Add to dashboard Cite

Purpose To evaluate patients with prolactinoma treated surgically in a time when elective prolactinoma surgery became routine in our center, using a comprehensive outcome set, focusing on preoperative assessments, surgical outcomes, and health-related quality of life (HR-QoL). Methods Cohort of consecutive patients with prolactinoma undergoing surgery between January 2021 and August 2023. Clinical data were collected during multidisciplinary team (MDT) meetings/from medical records at distinct timepoints: (1) pre-surgery, (2) two weeks post-surgery, (3) six months post-surgery, and (4) follow-up (median 15.0 (10.0-24.8 months). HR-QoL was measured using the Leiden Bothers and Needs Pituitary (LBNQ-P) questionnaire. Data were described for all patients, and patients undergoing elective total resection, with additional subgroups of (a) patients undergoing a high-probability-first-total-resection, and (b) reoperations aiming for total resection. Results One hundred surgically treated patients with prolactinoma were included (72 female). Dopamine agonist intolerance was the most frequent indication (n=68). The surgical goal (debulking/total resection) was achieved in 90% of patients. Long-term complications occurred in 4% of patients. Seventy-eight patients underwent an elective total resection, achieving remission in 91%. The subsets of preoperatively estimated high-probability-first-total-resections (n=52), and reoperations (n=9), achieved remission in 92% and 89%, respectively. LBNQ-P Total Bothers and Total Needs scores improved significantly after surgery (p<0.001, Δ-3.4 (IQR -14.4- -0.9) and p=0.006, Δ-1.8 (IQR -11.9-1.3), respectively. Conclusion High remission rates were achieved, improving HR-QoL, evidencing (repeat) prolactinoma surgery is effective in an experienced pituitary center, as highlighted in the most recent guideline (2023).

show abstract

Efficacy and Safety of Endoscopic Transsphenoidal Resection for Prolactinoma: A Retrospective Multicenter Case-series

Cited by 3 publications

References 35 publications

Role of Medical and Surgical Treatment in Management of the Patients With Prolactinoma: A Single-Center Experience

Role of Medical and Surgical Treatment in Management of the Patients With Prolactinoma: A Single-Center Experience

Prolactinoma: navigating the dual challenge of side effects and treatment strategies - a comprehensive narrative review

The Changing Treatment Paradigm for Prolactinoma—A Prospective Series of 100 Consecutive Neurosurgical Cases

Contact Info

Product

Resources

About