10-year follow-up study comparing primary medical vs. surgical therapy in women with prolactinomas.
While dopamine-agonists are the first-line approach in treating prolactinomas, surgery can be considered in selected cases besides non-responders or patients with dopamine-agonist intolerance. The aim of the present study was to compare the long-term outcome in women with prolactinomas treated primarily either surgically or medically who had not had prior dopamine-agonist treatment. Retrospective case-note study of all consecutive women with prolactinomas primarily managed with medical therapy or surgery in a tertiary referral centre. The clinical, biochemical, and radiological responses to first-line treatment at early and long-term follow-up were analysed. The primary therapeutic strategy was dopamine-agonists for 36 (34 %) and surgery for 71 (66 %) of the women. Baseline clinical and biochemical characteristics were not significantly different between the primary surgical and medical cohort. Median follow-up time was 90 months (range 13-408). Following primary treatment, prolactin level significantly decreased in both cohorts, on average to 13.5 µg/L (IQR 7-21; p < 0.001), and was within the normal range in 82 % of all patients. No women in the surgical cohort demonstrated permanent sequelae and morbidity was low. At final follow-up, control of hyperprolactinaemia required dopamine-agonist therapy in 64 % of women who had undergone primary medical therapy vs. 32 % of those who had primary surgical therapy (p = 0.003). Logistic regression revealed that the primary therapeutic strategy, but not adenoma size, was an independent risk factor for long-term dependence on dopamine-agonists. The present data indicate that in a dedicated tertiary referral centre, long-term control of hyperprolactinaemia in women with prolactinomas is high. In selected cases, a primary neurosurgical approach might at least be interdisciplinarily discussed with the primary goal of minimizing long-term dependence on dopamine-agonists.
Departments of Neurosurgery, Bern University Hospital, University of Bern, Bern, Switzerland.
Lukas
L
Andereggen
Endocrinology Diabetes and Metabolism, Bern University Hospital, University of Bern, Bern, Switzerland.
Janine
J
Frey
Departments of Neurosurgery, Bern University Hospital, University of Bern, Bern, Switzerland.
Robert H
RH
Andres
Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Marwan
M
El-Koussy
Departments of Neurosurgery, Bern University Hospital, University of Bern, Bern, Switzerland.
Jürgen
J
Beck
Departments of Neurosurgery, Bern University Hospital, University of Bern, Bern, Switzerland.
Rolf W
RW
Seiler
Endocrinology Diabetes and Metabolism, Bern University Hospital, University of Bern, Bern, Switzerland. emanuel.christ@insel.ch.
Emanuel
E
Christ
D000328:Adult; D001971:Bromocriptine / Q000627:therapeutic use; D000077465:Cabergoline; D018491:Dopamine Agonists / Q000627:therapeutic use*; D004873:Ergolines / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D010902:Pituitary Gland / Q000601:surgery*; D010911:Pituitary Neoplasms / Q000097:blood / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D011388:Prolactin / Q000097:blood*; D015175:Prolactinoma / Q000097:blood / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
D018491:Dopamine Agonists; D004873:Ergolines; D001971:Bromocriptine; D011388:Prolactin; D000077465:Cabergoline
Long-term results; Primary medical therapy; Primary surgical therapy; Prolactinoma; Women
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