Current indications for the surgical treatment of prolactinomas.
The purpose of this study was to examine the current indications for transsphenoidal surgery in the prolactinoma patient population, and to determine the outcomes of patients who undergo such operations. Transsphenoidal surgery may be indicated in prolactinoma patients who are resistant and/or intolerant to dopamine agonist (DA) therapy. We performed a retrospective review of the medical records of prolactinoma patients over a 6 year period (April 2008 to April 2014) at a large volume academic center. The median follow-up time was 12.0 months (range: 3-69). All patients who were included in the study (n=66) were treated with DA therapy and subsequently underwent an endonasal transsphenoidal operation. Of the 66 patients, 44 were women (mean age 34.2 years) and 22 were men (mean 41.7 years). There were 29 (43.9%) intolerant patients and 29 (43.9%) resistant patients. Postoperatively, 18 intolerant patients (66.7%) had normalized prolactin levels without the need for DA therapy, and five (17.2%) required DA to normalize their prolactin levels (p=0.02). Six patients (20.6%) had persistently elevated prolactin levels but were no longer receiving DA treatment (p<0.001). Postoperatively, 10 resistant patients (35.7%) had normal prolactin levels without DA therapy, and seven patients (25%) were treated with DA therapy to normalize their prolactin levels (p=0.22). Eight patients (28.6%) had supraphysiologic prolactin levels but were no longer taking a DA (p<0.001). Three patients (10.7%) were hyperprolactinemic, despite postoperative treatment with DA (p<0.001). After an appropriate treatment interval with multiple DA, radiographic follow-up, and careful clinical evaluation, prolactinoma patients can be offered surgery as an effective therapeutic option.
Department of Neurosurgery, Brigham and Women's Hospital, 15 Francis Street, Boston, MA 02115, USA. Electronic address: trsmith@partners.org.
Timothy R
TR
Smith
Department of Neurosurgery, Brigham and Women's Hospital, 15 Francis Street, Boston, MA 02115, USA.
M Maher
MM
Hulou
Department of Neurosurgery, Brigham and Women's Hospital, 15 Francis Street, Boston, MA 02115, USA.
Kevin T
KT
Huang
Department of Neurosurgery, Brigham and Women's Hospital, 15 Francis Street, Boston, MA 02115, USA.
Abdulkerim
A
Gokoglu
Department of Neurosurgery, Brigham and Women's Hospital, 15 Francis Street, Boston, MA 02115, USA.
David J
DJ
Cote
Department of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston, MA, USA.
Whitney W
WW
Woodmansee
Department of Neurosurgery, Brigham and Women's Hospital, 15 Francis Street, Boston, MA 02115, USA.
Edward R
ER
Laws
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018491:Dopamine Agonists / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D009666:Nose / Q000601:surgery; D010911:Pituitary Neoplasms / Q000601:surgery*; D011184:Postoperative Period; D015175:Prolactinoma / Q000601:surgery*; D012189:Retrospective Studies; D013101:Sphenoid Sinus / Q000601:surgery
D018491:Dopamine Agonists
Dopamine agonist; Intolerance; Prolactinoma; Resistance; Transsphenoidal surgery