Predictive value of serum prolactin levels measured immediately after transsphenoidal surgery

Abstract

Prolactin levels lower than 10 ng/ml on POD 1 predict a long-term chemical cure in patients with microadenomas (100% cure rate) and those with macroadenomas (93% cure rate). In contrast, a cure is not likely to be obtained in patients with normal levels ranging between 10 and 20 ng/ml on POD 1 if they harbor macroadenomas (0% cure rate). A recurrence reported several years after surgery probably represents the presence of persistent tumor that was not originally removed. If the initial operation was performed by an experienced surgeon, however, reoperation is not likely to yield a chemical cure.

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

“…The clinical characteristics of our patients were similar in many other aspects to those reported in recent surgical series (17,18,19,20,21). As also shown here, the mean age of operated patients usually ranges between 30 and 38 years, men represent 25-40% of them and have higher PRL levels and larger tumors (19,20).…”

“…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.…”

“…The remission rate observed here for microprolactinomas is lower compared with those (78-93%) reported in several recent series (17,18,19,21,22,23), but similar to the success rate reported in one study (20) and higher than that reported by Menucci et al (24). In fact, our study included patients who underwent surgery in different institutions over a long timespan between 1979 and 2010, while most recent studies were from single experienced centers and included patients treated after 1990.…”

“…Few studies have recently re-examined the outcome of patients treated by transsphenoidal surgery for a prolactinoma (17,18,19,20,21,22,23,24). They reported variable remission rates for microprolactinomas (between 50 and 93%) and macroprolactinomas (between 30 and 80%), as well as a highly variable frequency of recurrences between 5 and 58%, the latter variability being mainly dependent on the length of the follow up and the indication retained for surgery.…”

Effectiveness of Endoscopic Endonasal Transsphenoidal Surgery Using a Neuronavigation: Clinical Results of 178 Pituitary Adenomas

“…Hormonal remission in patients with acromegaly was defined as GH levels after OGTT <1 µg/dL and restoration of IGF-I levels to normal for age and sex [10][11][12]. Remission of prolactinoma was defined as serum PRL <10 ng/mL on the day after surgery [13],…”