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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
,
Pinar Kadioglu 
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.
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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.

Keywords

endoscopic transsphenoidal surgery - dopamine agonists - prolactinoma - remission - treatment


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

 

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