Late recurrence of surgically removed prolactinomas

Parl, Fritz F.; Cruz, Victoria E.; Cobb, Cully A.; Bradley, Charles; Aleshire, Stephen L.

doi:10.1002/1097-0142(19860615)57:12<2422::aid-cncr2820571229>3.0.co;2-b

Cited by 20 publications

(5 citation statements)

References 25 publications

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“…Although surgical resection of the adenomaoffers a potential for cure, in fact cure was later found to be achieved in a minority of patients with large tumors and was associated with a risk of recurrence in all patients. Hyperprolactinemia recurs one to five years after surgery in 10 to 50%of patients with microprolactinomas and in 20 to 91% of patients with macroprolactinomas (3,(4)(5)(6)(7)(8)(9). Radiotherapy rarely results in the restoration of normal serum prolactin concentrations and therefore is generally not considered as a primary treatment for prolactinomas.…”

Section: Introductionsupporting

confidence: 87%

Comparison of the Effects of Cabergoline and Bromocriptine on Prolactin Levels in Hyperprolactinemic Patients.

et al. 2001

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Objective It is well knownthat bromocriptine has a suppressive effect on the prolactin release in hyperprolactinemic patients. But it also has someadverse effects. The new, long-acting dopaminergic drug, cabergoline, has been reported to be an effective agent in these patients. However, there are relatively few reports comparing the beneficial and adverse effects of these drugs in the treatment of hyperprolactinemic patients. Therefore, here we studied and compared the efficacy and tolerability of cabergoline with bromocriptine in hyperprolactinemic patients.Patients Seventeen patients (7 with microprolactinoma, 4 with macroprolactinoma, 6 with idiopathic hyperprolactinemia) were given bromocriptine at a dose of 2.5 mg (or 5 mgfor macroprolactinomas) twice daily, and 17 patients (8 with microprolactinoma, 4 with macroprolactinoma, 5 with idiopathic hyperprolactinemia) were given cabergoline at a dose of 0.5 mg twice weekly for 12 weeks. Results At the end of the study, the prolactin reduction was significantly greater in the cabergoline group than in the bromocriptine group (-93 vs. -87.5%, respectively, p<0.05). Normalization of prolactin levels was achieved in 10 of 17 patients (59%) in the bromocriptine group, and in 14 of 17 patients (82%) in the cabergoline group (p=0.13).Twopatients (50%) with macroprolactinoma in the bromocriptine group and three patients (75%) with macroprolactinoma in the cabergoline group demonstrated a normalization of their serum prolactin levels. Adverse events were noted in 53%of bromocriptine patients and in 12% of cabergoline patients (p<0.01). Conclusion These data indicate that cabergoline is a very effective agent for lowering the prolactin levels in hyperprolactinemic patients and that it appears to offer considerable advantage over bromocriptine in terms of efficacy and tolerability.

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Section: Introductionsupporting

confidence: 87%

Comparison of the Effects of Cabergoline and Bromocriptine on Prolactin Levels in Hyperprolactinemic Patients.

et al. 2001

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“…In prolactinoma, age [15, 21, 24, 27, 144], gender [21, 23, 24, 27] and macroscopic and microscopic tumor invasion were not significant factors for recurrence [15, 21, 24, 26, 27]. Tumor size was not a convincing factor [7, 8, 10, 15, 30, 34, 144] while a low basal postoperative PRL concentration (below 10 or 6 μg/L thus much lower than the upper normal basal PRL level of 20 or 22 μg/L) [7, 15, 23, 24, 28, 30, 34, 144] and normalization of the TRH test were favorable clinical factors associated with permanent cure [10, 21, 30].…”

Section: Resultsmentioning

confidence: 99%

Clinical factors involved in the recurrence of pituitary adenomas after surgical remission: a structured review and meta-analysis

2011

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To study the currently available data of recurrence rates of functioning and nonfunctioning pituitary adenomas following surgical cure and to analyze associated predisposing factors, which are not well established. A systematic literature search was conducted using Medline, Embase, Web of Science and the Cochran Library for studies reporting data on recurrence of pituitary adenoma after surgery, in nonfunctioning adenoma (NF), prolactinoma (PRL) acromegaly (ACRO) and Cushing’s disease (CUSH). Of 557 initially retrieved potential relevant studies 143 were selected. Recurrence in NFA was defined as reappearance of tumor on MRI or CT. Increase of hormone levels above normal limits as set by the authors after initial remission was used to indicate recurrence in the functioning tumor types. Remission percentage was lowest in NFA compared with other tumor types (P < 0.001). Surgery-related hypopituitarism was more frequent in CUSH than in the other tumors (P < 0.001). Recurrence, expressed as percentage of the cured population or as ratio of recurrence and total patient years of follow-up was highest in PRL (P < 0.001). The remission percentage did not improve over 3 decades of publications, but there was a modest decrease in recurrence rate (P = 0.04). Recurrences peaked between 1 and 5 years after surgery. Most of the studies with a sufficient number of recurrences did not apply multivariate statistics, and mentioned at best associated factors. Age, gender, tumor size and invasion were generally unrelated to recurrence. For functioning adenomas a low postoperative hormone concentration was a prognostically favorable factor. In NFA no specific factor predicted recurrence. Recurrence rate differs between pituitary adenomas, being highest in patients with prolactinoma, with the highest incidence of recurrence between 1 and 5 years after surgery in all adenomas. Patients with NFA have a lower chance of remission than patients with functioning adenomas. The postoperative basal hormone level is the most important predictor for recurrence in functioning adenomas, while in NFA no single convincing factor could be identified.

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“…In our study, about 34% of patients with postoperative remission relapsed 7-164 months after initial surgery, a recurrence rate higher than those reported in recent studies (17,18,19,20,21) but similar to findings from older publications with long follow-up periods of up to 148 months (29,30,31,32). Noticeably, recurrence of hyperprolactinemia seems to occur at a constant rate over time and half of the relapsing patients did so 3 years or more after surgery.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of transsphenoidal surgery in prolactinomas: improvement of hormonal control in dopamine agonist-resistant patients

Primeau

Raftopoulos

Maiter

2012

European Journal of Endocrinology

130

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Context: Few studies have recently re-examined the efficacy of neurosurgery in prolactinoma patients operated for various indications. Objective: To analyze outcomes of patients with a prolactinoma treated by transsphenoidal surgery, to identify factors associated with remission and relapse, and to evaluate if surgical debulking allows for better hormonal control in patients with preoperative resistance to dopamine agonists (DAs). Patients and methods: This was a retrospective review of patients with a benign prolactinoma followed preoperatively and postoperatively in our department and treated by transsphenoidal surgery (nZ63; 45 women; mean age: 31G14 years). Results: Postoperative remission was obtained in 63% of microprolactinomas, 60% of noninvasive macroprolactinomas, and none of the invasive macroprolactinomas. Better remission rate was independently predicted by lower diagnostic prolactin (PRL) levels and by the lack of abnormal postoperative residual tissue (P!0.05). A recurrence of hyperprolactinemia was observed in 34% of patients after a median follow-up period of 36 (7-164) months. In patients with preoperative DA resistance treated again after surgery, there was a significant reduction in PRL levels postoperatively (26 (6-687) ng/ml) vs preoperatively (70 (22-1514) ng/ml; P!0.01) under a lower DA dose, and about half of the patients had PRL normalization. Conclusions: Recurrence of hyperprolactinemia is observed in one-third of prolactinoma patients after surgical remission and may occur as late as 13 years after surgery. Resistance to DA can be considered as a good surgical indication, as partial tumor resection allows for better hormonal control with a lower dose of DAs.

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Late recurrence of surgically removed prolactinomas

Cited by 20 publications

References 25 publications

Comparison of the Effects of Cabergoline and Bromocriptine on Prolactin Levels in Hyperprolactinemic Patients.

Comparison of the Effects of Cabergoline and Bromocriptine on Prolactin Levels in Hyperprolactinemic Patients.

Clinical factors involved in the recurrence of pituitary adenomas after surgical remission: a structured review and meta-analysis

Outcomes of transsphenoidal surgery in prolactinomas: improvement of hormonal control in dopamine agonist-resistant patients

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