Recurrence of Hyperprolactinemia after Selective Transsphenoidal Adenomectomy in Women with Prolactinoma

Abstract

To assess the long-term prognosis for women with prolactinoma after selective transsphenoidal adenomectomy, we followed 44 patients for 6.2 +/- 1.5 years. Group 1 (28 patients) had microprolactinomas, and Group 2 (16 patients) had macroprolactinomas. After surgery, normal plasma prolactin levels, resumption of menses, and cessation of galactorrhea were observed in 24 Group 1 patients (85 per cent) and 5 Group 2 patients (31 per cent). Hyperprolactinemia recurred in 12 of the 24 Group 1 patients and in 4 of the 5 Group 2 patients after 4 +/- 1.3 and 2.5 +/- 1.6 years of remission, respectively. There was no radiologic evidence of tumor recurrence in any patient, and no relation was found between the occurrence of pregnancy after surgery and the recurrence of hyperprolactinemia. Clinical and biologic features before surgery could not predict the long-term outcome. However, the immediate postoperative level of plasma prolactin was significantly lower in patients in whom normal prolactinemia (6.4 +/- 1.1 ng per milliliter) was maintained than in those who relapsed (11.7 +/- 1.5 ng per milliliter) (P less than 0.02). We conclude that recurrence of hyperprolactinemia after successful surgery is frequent but delayed. The immediate postoperative level of plasma prolactin may be a predictive risk factor.

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

“…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.…”

Stereotactic radiosurgery for hypersecreting pituitary tumors: part of a multimodality approach

“…32,38 The recurrence rate is also greater (as high as 80%). 32,41 Based on this series, it is our finding that in difficult cases GKS can induce a remission in an additional 11% of patients off medication.…”

“…32,38 In patients with microprolactinomas, the lesion recurs in 17 to 50%. 32,41 In patients with macroprolactinomas surgical remission is less successful, occurring in 28 to 53% of patients. 32,38 The recurrence rate is also greater (as high as 80%).…”

Management of resistant prolactinoma in infertile lady with successful maternal and perinatal outcome

“…The success rates are highly variable ranging from 6.7 to 80% and recurrence rate being 7-50%. 10, 11 Maiter D et al in 2014 reviewed the management of giant prolactinoma cases and found that the extensive tumours are usually not completely resectable and neurosurgery has significant morbidity and mortality. 12 So additional therapy after operation using conventional external radiation may be needed, but it takes several years to achieve endocrinological remission and risk for panhypopituitarism or visual disturbances exists.…”