Abstract and Introduction
Context: Surgical management of prolactinomas is an important treatment for patients intolerant of dopamine agonist therapy. However, predictors of postoperative outcomes remain unclear.
Object: While transsphenoidal surgical resection (TSSR) is important second-line therapy in prolactinoma patients, predictors of surgical cure and biochemical remission following TSSR remain sparse.
Methods: A retrospective review of prolactinoma patients undergoing TSSR at the USC Pituitary Center from 1995 to 2020 was conducted. Participants were categorized as surgical cure (normalization of serum prolactin without medical treatment), surgical noncure, biochemical control (prolactin normalization with or without adjuvant therapy), and nonbiochemical control. A systematic review of the outcomes of surgically managed prolactinomas was performed.
Results: The 40 female and 16 male participants had an average age of 35.6 years. Prior treatment included transsphenoidal resection (6, 11%) and dopamine agonist treatment (47, 84%). The 40 macroadenomas and 15 microadenomas exhibited suprasellar extension (24, 43%) and parasellar invasion (20, 36%). Fifteen (27%) were purely intrasellar. Gross total resection was achieved in 25 patients (45%) and subtotal in 26 (46%). Surgical cure was achieved in 25 patients (46%) and biochemical control in 35 (64%). Surgical cure was more likely in smaller, noninvasive tumors, those that were fully resected, and patients with lower preoperative (< 1000 ng/mL) and immediately postoperative (< 7.6 ng/mL) prolactin levels. Ten of 26 patients (38%) undergoing adjuvant therapy achieved biochemical control, which was less likely in men and those with higher preoperative prolactin or invasive tumors.
Conclusion: Surgical resection of prolactinomas is a safe procedure that, when offered judiciously, can achieve symptom and/or biochemical control in a majority of patients. A variety of predictors may be useful in advising patients on likelihood of postoperative remission.
Prolactinomas are prolactin-secreting adenomas arising from lactotroph cells of the pituitary gland, and comprise approximately 40% of pituitary tumors. There are 2 predominant categories of symptoms with which prolactinoma patients present: those due to elevated prolactin and its inhibition of gonadotropin-releasing hormone and those due to tumor mass effect. An increase in prolactin secretion commonly results in reproductive and sexual dysfunction, including oligomenorrhea, galactorrhea, and amenorrhea in women and decreased libido in men. Symptoms of mass effect include headaches, vision loss, and hypopituitarism and are usually seen in patients with macroprolactinomas.
Standard of care for treatment of prolactinomas centers around dopamine agonist (DA) therapy, which in the majority of cases is remarkably effective.[4,5] Surgical resection is usually reserved for patients who are intolerant or resistant to DA therapy, as well as for some women harboring tumors who are considering pregnancy. Prior studies have reported postsurgical biochemical control rates ranging between 50% and 93% for microprolactinomas and between 30% and 80% for macroprolactinomas[7–13] with mean follow-up of 19.6 to 138 months.
Although the effectiveness of surgical resection as a second-line therapy for prolactinomas has been reported, predictors of surgical cure (hormonal remission without postoperative DA therapy) and biochemical control with or without adjuvant postoperative DA therapy have not been extensively studied.
J Endo Soc. 2021;5(10) © 2021 Endocrine Society