Trans-sphenoidal surgery for microprolactinoma: an acceptable alternative to dopamine agonists?

Turner, Helen; Adams, C. B. T.; Wass, John

doi:10.1530/eje.0.1400043

Cited by 69 publications

(41 citation statements)

References 19 publications

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“…Based on a study from the UK published in 1999 (38), the costs for a hypothetical patient with microprolactinoma undergoing surgery and cure with no complications and followed up for 10 years did not differ from those required for a patient receiving cabergoline 1 mg/week for 10 years.…”

Section: Quality Of Life and Costsmentioning

confidence: 99%

THERAPY OF ENDOCRINE DISEASE: Surgery in microprolactinomas: effectiveness and risks based on contemporary literature

Tampourlou

Trifănescu

Paluzzi³

et al. 2016

European Journal of Endocrinology

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Microprolactinomas are the most common pituitary adenomas. In symptomatic patients, dopamine agonists are the first-line treatment of choice; when cabergoline is used, biochemical control rates between 85 and 93% have been reported. Long-term treatment is needed in most of the cases with compliance, patient convenience, and potential adverse effects representing areas requiring attention. Based on the literature published in the past 15 years, transsphenoidal surgery can lead to normal prolactin in the postoperative period in usually 71 -100% of the cases with very low postoperative complication rates. Surgical expertise is the major determinant of the outcomes, and it may be a cost-effective option in young patients with life expectancy greater than 10 years (provided it is performed by experienced surgeons at high volume centers with confirmed optimal outcomes). Larger series of patients with adequate follow-up could further validate the place of transsphenoidal surgery (particularly through the endoscopic approach for which long-term results are currently limited) in the management algorithm of patients with microprolactinoma. 175:3R89-R96 M Tampourlou and others Surgery for microprolactinomas

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Section: Quality Of Life and Costsmentioning

confidence: 99%

THERAPY OF ENDOCRINE DISEASE: Surgery in microprolactinomas: effectiveness and risks based on contemporary literature

Tampourlou

Trifănescu

Paluzzi³

et al. 2016

European Journal of Endocrinology

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“…Some believe, however, that patients with microadenomas can be successfully treated medically or surgically (Turner et al 1999). It is crucial not to offer surgery as a first-line option except in centers where there has been an established high success rate, given the variability of outcomes reported in the literature (Tyrrell et al 1999).…”

Section: Treatment Of Patients With Microprolactinomas: Surgery Versumentioning

confidence: 99%

Pituitary tumors: pathophysiology, clinical manifestations and management.

Arafah¹,

Nasrallah²

2001

Endocrine-Related Cancer

185

141

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Pituitary tumors are frequently encountered intracranial neoplasms. They present with a variety of clinical manifestations that include symptoms and signs of excessive hormone secretion by the tumor, signs of hormone deficits by the normal pituitary gland and others related to expansion of the tumor mass and the resulting compression of surrounding structures such as the optic chiasm and cranial nerves. Advances in molecular biology, immunocytochemical staining and imaging, and the introduction of new treatment options have improved our understanding of the natural history of these adenomas and their management. Available treatments include surgical, medical and radiation therapy. Although the primary treatment for each tumor type may vary, it is important to consider all available options and select the most applicable for that patient. The interaction of all members of management team, including the primary care provider, the endocrinologist and the neurosurgeon in selecting the treatment course can only improve therapeutic outcome. Regardless of the initial choice of treatment, follow-up of all patients should be maintained indefinitely. The managing physician should be familiar with the natural history and long-term complications of pituitary adenomas, and with the side effects of treatments given over the years.

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“…In contrast, transsphenoidal surgery is currently only seen as a secondline treatment, although the published surgical rates of PRL level normalization in specialized centers, especially for microprolactinomas, are excellent and at least comparable with dopamine agonist therapy varying between 67 and 88% (24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34).…”

Section: Introductionmentioning

confidence: 99%

Operative treatment of prolactinomas: indications and results in a current consecutive series of 212 patients

Kreutzer¹,

Buslei²,

Wallaschofski³

et al. 2008

European Journal of Endocrinology

160

102

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Objective: Medical therapy with dopamine agonists (DA) is the primary treatment of choice in most patients with prolactinomas. 'Classical' surgical indications are intolerance or lack of efficiency of DA therapy. Focusing on a possible shift of recent indications, we retrospectively analyzed our results of surgical treatment in prolactinomas. Patients and methods: Between 1990 and 2005, we have operated on 212 consecutive patients with prolactinomas. Surgical indications were divided into 'classical' indications and 'modern' indications defined as cystic prolactinomas or patients with microprolactinomas who individually decided on a primary surgical treatment. Results: Initial overall remission was accomplished in 53.2% including giant prolactinomas. However, in microadenomas, the remission rate was significantly higher with 91.3%. Overall remission at the latest follow-up was 42.7%, but 72.5% in intrasellar tumors, 80% in cystic prolactinomas, and 84.8% in microprolactinomas. The overall recurrence rate was 18.7%. Relapse of hyperprolactinemia in microprolactinomas was 7.1%. In our series, continually less patients were surgically treated for 'classical' indications. By contrast, the number of patients who individually decided on a primary surgical therapy has increased considerably. Conclusion: Remission rates after surgical treatment of prolactinomas remain excellent, particularly in microadenoma and intrasellar macroadenomas, whereas morbidity of transsphenoidal surgery is low in the hands of experienced pituitary surgeons. Our remission rates not only confirm the already interdisciplinarily accepted surgical indications, but also emphasize the value of primary transsphenoidal surgery as a discussion-worthy alternative to dopaminergic therapy in young patients with microprolactinomas or cystic tumors.

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Trans-sphenoidal surgery for microprolactinoma: an acceptable alternative to dopamine agonists?

Cited by 69 publications

References 19 publications

THERAPY OF ENDOCRINE DISEASE: Surgery in microprolactinomas: effectiveness and risks based on contemporary literature

THERAPY OF ENDOCRINE DISEASE: Surgery in microprolactinomas: effectiveness and risks based on contemporary literature

Pituitary tumors: pathophysiology, clinical manifestations and management.

Operative treatment of prolactinomas: indications and results in a current consecutive series of 212 patients

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