Prolactinoma

Haider, Sameah; Levy, Shiri; Rock, Jack; Craig, John R.

doi:10.1016/j.otc.2021.12.005

Cited by 12 publications

(6 citation statements)

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“…The majority of EPAs are definitively diagnosed following surgery and histopathological examination 11 . Surgery should be considered in pituitary prolactinomas when: the patient cannot tolerate medical therapy, medical therapy is ineffective, there are macroadenomas with a cystic component, or there is optic nerve compression 12 . However, ectopic prolactin‐secreting adenoma's management remains controversial between medical and surgical 13 .…”

Section: Discussionmentioning

confidence: 99%

“…11 Surgery should be considered in pituitary prolactinomas when: the patient cannot tolerate medical therapy, medical therapy is ineffective, there are macroadenomas with a cystic component, or there is optic nerve compression. 12 However, ectopic prolactin-secreting adenoma's management remains controversial between medical and surgical. 13 The transsphenoidal approach is an excellent method for accessing clival tumors, offering favorable exposure for surgical intervention.…”

Section: Discussionmentioning

confidence: 99%

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Clival ectopic pituitary prolactinoma was successfully managed by transsphenoidal surgery: A rare case report

Mansour,

Khozamah,

Naksho

et al. 2023

Clinical Case Reports

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Key Clinical MessageEctopic pituitary adenoma is a rare neoplasm located in the clivus and could mimic other clival tumors. Diagnosis and treatment could be challenging. It should be considered in the differential diagnosis of clival tumors.AbstractEctopic pituitary adenomas (EPAs) are isolated adenomas that can be located in variable locations outside the sella turcica and have a normal‐appearing pituitary gland. These tumors are rare and are thought to often arise from embryological remnants along the route of Rathke's pouch migration. EPAs are associated with a wide range of clinical manifestations depending on hormonal activity and involvement of adjacent structures, which can represent a challenge in making the diagnosis and deciding on the most appropriate management. In this case study, we report a 47‐year‐old male who presented with visual disturbances, a headache, and generalized weakness. Magnetic resonance imaging showed a 2 cm mass located in the clivus invading the sphenoid sinus with an intact pituitary gland. The patient underwent endoscopic transsphenoidal surgery to eradicate the mass while maintaining the integrity of the pituitary gland, which was successful and uneventful. Pathological studies were consistent with prolactinoma, with no cytological malignant features. Post‐surgery, symptoms notably improved, and serum prolactin levels significantly dropped, The patient's condition was satisfactory on follow‐up with no long‐term complications reported. This paper contributes to the existing literature by sharing the clinical management of a challenging and uncommon case.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clival ectopic pituitary prolactinoma was successfully managed by transsphenoidal surgery: A rare case report

Mansour,

Khozamah,

Naksho

et al. 2023

Clinical Case Reports

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“…A small proportion of patients with prolactinomas are resistant to drug therapy (3%-12%) or do not tolerate the side effects of drugs (3%-11%) (20,21). In this group of patients with unsuccessful DA therapy, surgical treatment is recommended and postoperative permanent remission is about 72%, according to literature data (21,22). Some studies have shown promising results with transsphenoidal surgery (TSS) as the first-line prolactinoma therapy (23)(24)(25).…”

Section: Introductionmentioning

confidence: 99%

Prognostic factors for surgical treatment of prolactin-secreting pituitary adenomas

Voznyak,

Zinkevych,

Lytvynenko

et al. 2024

Front. Surg.

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IntroductionUsually, prolactinomas are treated with dopamine agonists (DA). Surgery is considered an option when the patient cannot bear or does not respond positively to DA therapy.AimThis study aims to determine the early and late outcomes of surgery, with particular emphasis on developing prognostic factors for surgical treatment and analyzing risk factors affecting the recurrence of hyperprolactinemia and prolactinoma.Material and methodsThis retrospective study was conducted at the Feofaniya Clinical Hospital of the State Administration of Affairs (Kyiv, Ukraine), evaluating 109 patients' records from 2009 to 2019. The main patients' inclusion criteria were: serum prolactin (PRL) level of more than 100 ng/ml, presence of pituitary adenoma (PA) on MRI, histologically approved PA by microscopy. According to the size of the prolactin-secreting PA (PSPAs) the selected 109 patients were divided into two groups: micro- (≤10 mm, n = 75) and macroadenoma group (10–40 mm, n = 34).Results1 month after the operation, PRL levels decreased by 87% (p < 0.001), 12 months—by 93% (p < 0.001). After receiving surgery and DA therapy for 12 months 77.1% of patients achieved biochemical remission. Out of the total number of patients observed, 15.6% (n = 17) had a Knosp score greater than 3. Additionally, in the macroadenoma group, the percentage of patients with a Knosp score greater than 3 was 41,2%, which was significantly higher as compared to the microadenoma group (4%, p < 0.001). In patients with microadenomas a weak reverse correlation between patients' age (r = −0.258, p < 0.026) and positive with tumor size (r = 0.251, p < 0.030) was revealed. In the macroadenoma group significant association was found only between preoperative serum PRL level and tumor size (r = 0.412, p < 0.016). The preoperative PRL can be used as a diagnostic marker for lack of early biochemical remission in patients with PSPAs with diagnostic accuracy 66.9%.ConclusionsThis study found that primary transsphenoidal surgery is an effective treatment in reaching PRL level control in patients with both micro- and macroprolactinomas. The correct and thorough selection of candidates for surgery is crucial to achieve postoperative serum PRL normalization in the vast majority of patients.

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“…Prolactinomas represent the most common functional pituitary adenomas (PAs), accounting for approximately 40% of all PAs [ 1 ]. Clinical presentations in prolactinomas patients correlate with either hormonal dysfunction along the hypothalamic-pituitary axis (HPA; e.g., menstrual cycle irregularities galactorrhea and infertility in women, decreased libido and impotence in men) or mass effects (e.g., headache or dizziness, visual flied defects and hypopituitarism) [ 2 ]. To normalize hyperprolactinemia and reduce tumor volume, Dopamine agonists (DA) serve typically first-line treatment for prolactinomas patients.…”

Section: Introductionmentioning

confidence: 99%

Operative treatment of cystic prolactinomas: a retrospective study

Yang

et al. 2023

BMC Endocr Disord

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Background The optimal therapeutic approach for cystic prolactinomas remains unclear. This study aimed to evaluate the remission rates of prolactinoma patients after surgical treatment and the risk factors affecting postoperative remission in cystic prolactinoma patients. Methods The clinical data were retrospectively compiled from 141 patients with prolactinomas (including 41 cases of cystic prolactinomas, 21 cases of solid microprolactinomas and 79 cases of solid macroprolactinomas) who underwent transsphenoidal surgery (TSS) between April 2013 and October 2021 at the First Affiliated Hospital of Sun Yat-sen University. Results Early postoperative remission was achieved in 65.83% (n = 27/41) of cystic prolactinomas, 80.95% (n = 17/21) of solid microprolactinomas and 40.51% (n = 32/79) of solid macroprolactinomas. The mean length of follow up in all patients was 43.95 ± 2.33 months (range: 6-105 months). The follow-up remission rates were 58.54%, 71.43% and 44.30% in cystic, solid micro- and solid macroprolactinomas, respectively. For cystic prolactinomas, the early postoperative remission rates in the patients with preoperative dopamine agonists (DA) treatment were significantly higher than those without preoperative DA treatment (p = 0.033), but the difference in the follow-up remission rates between these two groups was not significant (p = 0.209). Multivariate stepwise logistic regression analysis indicated that tumor size and preoperative prolactin (PRL) levels < 200 ng/ml were independent predictors for early postoperative remission in cystic prolactinomas. Conclusion For cystic prolactinomas, tumor size and preoperative PRL levels were independent predictors of early postoperative remission. Preoperative DA therapy combined with TSS may be more beneficial to cystic prolactinoma patients.

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Prolactinoma

Cited by 12 publications

References 50 publications

Clival ectopic pituitary prolactinoma was successfully managed by transsphenoidal surgery: A rare case report

Clival ectopic pituitary prolactinoma was successfully managed by transsphenoidal surgery: A rare case report

Prognostic factors for surgical treatment of prolactin-secreting pituitary adenomas

Operative treatment of cystic prolactinomas: a retrospective study

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