Exp Clin Endocrinol Diabetes 2024; 132(10): 570-580
DOI: 10.1055/a-2364-6027
Article

Role of Medical and Surgical Treatment in Management of the Patients With Prolactinoma: A Single-Center Experience

Guldana Zulfaliyeva
1   Department of Internal Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey (Ringgold ID: RIN532719)
,
Ahmet Numan Demir
2   Department of Endocrinology, Metabolism and Diabetes, Istanbul University-Cerrahpasa, Istanbul, Turkey (Ringgold ID: RIN532719)
,
Semih Can Cetintas
3   Department of Neurosurgery, Istanbul University-Cerrahpasa, Istanbul, Turkey (Ringgold ID: RIN532719)
,
Dilan Ozaydin
4   Department of Neurosurgery, Health Science University Kartal Dr Lutfi Kırdar City Hospital, Istanbul, Turkey
,
Necmettin Tanriover
3   Department of Neurosurgery, Istanbul University-Cerrahpasa, Istanbul, Turkey (Ringgold ID: RIN532719)
5   Pituitary Center, Istanbul University-Cerrahpasa, Istanbul, Turkey
,
2   Department of Endocrinology, Metabolism and Diabetes, Istanbul University-Cerrahpasa, Istanbul, Turkey (Ringgold ID: RIN532719)
5   Pituitary Center, Istanbul University-Cerrahpasa, Istanbul, Turkey
› Author Affiliations
Funding This study received no specific grants from public, commercial, or nonprofit entities.

Abstract

Background Current guidelines recommend dopamine agonists (DA) as the primary therapeutic approach for prolactinomas; however, emerging evidence suggests that surgical intervention can also yield favorable outcomes.

Objective To comprehensively evaluate prolactinoma patients undergoing surgical and medical treatments at our pituitary center.

Methods Retrospective review of mMedical records from prolactinoma patients treated between 2015 and 2022 was performedwere retrospectively reviewed. The study focused on treatment outcomes and remission rates while investigating factors influencing the success of both treatment modalities in achieving remission.

Results A total of 301 prolactinoma patients were included, of whom 199 were women. Among them, 235 were managed medically, while 66 underwent surgical intervention. The overall remission rates of patients treated with medical and surgery were similar at the final examination (Respectively respectively 82.9% and 81.8%, p=0.114). Factors associated with remission in both treatment modalities included female sex, low initial prolactin levels, small adenoma size, and absence of cavernous invasion. Compared to DA treatment, Ssurgical treatment demonstrated a higher rate of drug-free remission compared to DA treatment for microadenomas, and macroadenomas without cavernous invasion. In cases with cavernous invasion, standalone surgical treatment yielded a low rate of drug-free remission (7.7%); however, when combined with DA therapy post-surgery, remission rates increased to 66.7%.

Conclusion Medical treatment with DAs remains the preferred option for macroadenomas with cavernous sinus invasion, and giant adenomas, with surgery reserved for selected cases to address complications. Conversely, surgery emerges as the most effective modality for achieving remission in patients with microadenomas, and macroadenomas confined to the sella. The recommendation of DAs as first-line therapy for all patients has been withdrawn in the current guidelines, and individual treatment approaches based on tumor characteristics are emphasized. Our results support this approach.



Publication History

Received: 27 March 2024

Accepted after revision: 11 July 2024

Accepted Manuscript online:
11 July 2024

Article published online:
30 August 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Friesen HG. The discovery of human prolactin: A very personal account. Clin Invest Med 1995; 18: 66-72
  • 2 Liu JK, Das K, Weiss MH. et al. The history and evolution of transsphenoidal surgery. J Neurosurg 2001; 95: 1083-1096
  • 3 Schlechte J, Sherman B, Halmi N. et al. Prolactin-secreting pituitary tumors in amenorrheic women: A comprehensive study. Endocr Rev 1980; 1: 295-308
  • 4 Beach FA. Historical origins of modern research on hormones and behavior. Horm Behav 1981; 15: 325-376
  • 5 Freeman ME, Kanyicska B, Lerant A. et al. Prolactin: Structure, function, and regulation of secretion. Physiol Rev 2000; 80: 1523-1631
  • 6 Bevan JS, Webster J, Burke CW. et al. Dopamine agonists and pituitary tumor shrinkage. Endocr Rev 1992; 13: 220-240
  • 7 Melmed S, Casanueva FF, Hoffman AR. et al. Diagnosis and treatment of hyperprolactinemia: An Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2011; 96: 273-288
  • 8 Khan DZ, Hanrahan JG, Baldeweg SE. et al. Current and future advances in surgical therapy for pituitary adenoma. Endocr Rev 2023; 44: 947-959
  • 9 Andereggen L, Frey J, Andres RH. et al. First-line surgery in prolactinomas: Lessons from a long-term follow-up study in a tertiary referral center. J Endocrinol Invest 2021; 44: 2621-2633
  • 10 Honegger J, Nasi-Kordhishti I, Aboutaha N. et al. Surgery for prolactinomas: A better choice?. Pituitary 2020; 23: 45-51
  • 11 Brenton RS, Phelps CD. The normal visual field on the Humphrey field analyzer. Ophthalmologica 1986; 193: 56-74
  • 12 Mohr G, Hardy J, Comtois R. et al. Surgical management of giant pituitary adenomas. Can J Neurol Sci 1990; 17: 62-66
  • 13 Knosp E, Steiner E, Kitz K. et al. Pituitary adenomas with invasion of the cavernous sinus space: A magnetic resonance imaging classification compared with surgical findings. Neurosurgery 1993; 33: 610-618
  • 14 Duskin-Bitan H, Shimon I. Prolactinomas in males: Any differences?. Pituitary 2020; 23: 52-57
  • 15 Dzialach L, Sobolewska J, Zak Z. et al. Prolactin-secreting pituitary adenomas: Male-specific differences in pathogenesis, clinical presentation and treatment. Front Endocrinol (Lausanne) 2024; 15: 1338345
  • 16 Ozaydin D, Demir AN, Tanriover N. Evaluation of the gender effect in operated prolactinomas. Eur Res J 2023; 9: 1135-1141
  • 17 Delgrange E, Trouillas J, Maiter D. et al. Sex-related difference in the growth of prolactinomas: A clinical and proliferation marker study. J Clin Endocrinol Metab 1997; 82: 2102-2107
  • 18 Nishioka H, Haraoka J, Akada K. Growth potential of prolactinomas in men: Is it really different from women?. Surg Neurol 2003; 59: 386-391
  • 19 Ambulkar SS, Darves-Bornoz AL, Fantus RJ. et al. Prevalence of hyperprolactinemia and clinically apparent prolactinomas in men undergoing fertility evaluation. Urology 2022; 159: 114-119
  • 20 Colao A, Sarno AD, Cappabianca P. et al. Gender differences in the prevalence, clinical features and response to cabergoline in hyperprolactinemia. Eur J Endocrinol 2003; 148: 325-331
  • 21 Kadioglu P, Oral G, Sayitoglu M. et al. Aromatase cytochrome P450 enzyme expression in human pituitary. Pituitary 2008; 11: 29-35
  • 22 Akinci H, Kapucu A, Dar KA. et al. Aromatase cytochrome P450 enzyme expression in prolactinomas and its relationship to tumor behavior. Pituitary 2013; 16: 386-392
  • 23 Calle-Rodrigue RD, Giannini C, Scheithauer BW. et al. Prolactinomas in male and female patients: A comparative clinicopathologic study. Mayo Clin Proc 1998; 73: 1046-1052
  • 24 Schaller B. Gender-related differences in prolactinomas. A clinicopathological study [published correction in Neuro Endocrinol Lett 2005; 26: 628]. Neuro Endocrinol Lett 2005; 26: 152-159
  • 25 Fainstein Day P, Glerean M, Lovazzano S. et al. Gender differences in macroprolactinomas: Study of clinical features, outcome of patients and ki-67 expression in tumor tissue. Front Horm Res 2010; 38: 50-58
  • 26 Delgrange E, Sassolas G, Perrin G. et al. Clinical and histological correlations in prolactinomas, with special reference to bromocriptine resistance. Acta Neurochir (Wien) 2005; 147: 751-758
  • 27 Auriemma RS, Pirchio R, Pivonello C. et al. Approach to the patient with prolactinoma. J Clin Endocrinol Metab 2023; 108: 2400-2423
  • 28 Chanson P, Maiter D. The epidemiology, diagnosis and treatment of prolactinomas: The old and the new. Best Pract Res Clin Endocrinol Metab 2019; 33: 101290
  • 29 Tampourlou M, Trifanescu R, Paluzzi A. et al. Therapy of endocrine disease: Surgery in microprolactinomas: Eeffectiveness and risks based on contemporary literature. Eur J Endocrinol 2016; 175: R89-R96
  • 30 Losa M, Mortini P, Barzaghi R. et al. Surgical treatment of prolactin-secreting pituitary adenomas: Early results and long-term outcome. J Clin Endocrinol Metab 2002; 87: 3180-3186
  • 31 Wolfsberger S, Czech T, Vierhapper H. et al. Microprolactinomas in males treated by transsphenoidal surgery. Acta Neurochir (Wien) 2003; 145: 935-941
  • 32 Zamanipoor Najafabadi AH, Zandbergen IM, de Vries F. et al. Surgery as a viable alternative first-line treatment for prolactinoma patients. A systematic review and meta-analysis. J Clin Endocrinol Metab 2020; 105: e32-e41
  • 33 Casanueva FF, Barkan AL, Buchfelder M. et al. Criteria for the definition of Pituitary Tumor Centers of Excellence (PTCOE): A Pituitary Society Statement [published correction in Pituitary 2018 20]. Pituitary 2017; 20: 489-498
  • 34 Cozzi R, Ambrosio MR, Attanasio R. et al. Italian Association of Clinical Endocrinologists (AME) and International Chapter of Clinical Endocrinology (ICCE). Position statement for clinical practice: Prolactin-secreting tumors. Eur J Endocrinol 2022; 186: P1-P33
  • 35 Basile M, Valentini I, Attanasio R. et al. A pharmacoeconomic analysis from Italian guidelines for the management of prolactinomas. Glob Reg Health Technol Assess 2024; 11: 1-16
  • 36 Petersenn S, Fleseriu M, Casanueva FF. et al. Diagnosis and management of prolactin-secreting pituitary adenomas: A Pituitary Society International Consensus Statement. [published correction in Nat Rev Endocrinol 2023]. Nat Rev Endocrinol 2023; 19: 722-740
  • 37 Zandbergen IM, Huntoon KM, White TG. et al. Efficacy and safety of endoscopic transsphenoidal resection for prolactinoma: A retrospective multicenter case-series. Arch Med Res 2023; 54: 102919
  • 38 Demir D, Demir AN, Sulu C. et al. The combination of dopamine agonist treatment and surgery may be the best option in challenging prolactinoma cases: A single-centre experience. World Neurosurg 2023; 175: e1166-e1174
  • 39 Kreutzer J, Buslei R, Wallaschofski H. et al. Operative treatment of prolactinomas: Indications and results in a current consecutive series of 212 patients. Eur J Endocrinol 2008; 158: 11-18
  • 40 Mohr G, Hardy J, Comtois R. et al. Surgical management of giant pituitary adenomas. Can J Neurol Sci 1990; 17: 62-66
  • 41 Koutourousiou M, Gardner PA, Fernandez-Miranda JC. et al. Endoscopic endonasal surgery for giant pituitary adenomas: Advantages and limitations. J Neurosurg 2013; 118: 621-631
  • 42 Ke D, Xu L, Wu D. et al. Surgical management of giant pituitary adenomas: Institutional experience and clinical outcomes of 94 patients. Front Oncol 2023; 13: 1255768
  • 43 Shrivastava RK, Arginteanu MS, King WA. et al. Giant prolactinomas: Clinical management and long-term follow up. J Neurosurg 2002; 97: 299-306
  • 44 Chen Z, Shou X, Ji L. et al. Presurgical medical treatment in prolactinomas: Surgical implications and pathological characteristics from 290 cases. J Clin Endocrinol Metab 2024; 109: 1433-1442
  • 45 De Sousa SMC, Jukes AK, Candy NG. et al. Tumour fibrosis in dopamine agonist-exposed prolactinomas is a diminishing concern. Nat Rev Endocrinol 2024; 20: 314
  • 46 Jethwa PR, Patel TD, Hajart AF. et al. Cost-effectiveness analysis of microscopic and endoscopic transsphenoidal surgery versus medical therapy in the management of microprolactinoma in the United States. World Neurosurg 2016; 87: 65-76