Surgical Treatment of Prolactinomas: Potential Role as a First-Line Treatment Modality
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Purpose: Treatment with dopamine agonists (DAs) has been the first-line standard treatment for prolactinoma, and surgery has been reserved for drug intolerance and resistance for several decades. We evaluated whether surgery plays a primary role in pro lactinoma management. Materials and Methods: We conducted a retrospective study of 210 prolactinoma patients who had received surgical treatment at our institution. We analyzed the treatment outcomes according to tumor extent, sex, and preoperative DA medication. Results: Overall hormonal remission was achieved in 164 patients (78.1%), and complete removal was achieved in 194 patients (92.4%). When the tumors were completely removed, the remission rate increased to 84.5%. Anterior pituitary function was nor malized or improved in 94.6% of patients, whereas only 4.1% of patients showed worsening of hormone control. Hormonal remis sion was higher in patients who had not received DA preoperatively than in those who had received preoperative DA treatment. Smaller tumor size (<1 cm), no invasion into the cavernous sinus, and female sex were predictors of good surgical outcomes. Conclusion: Although DAs remain the first-line standard treatment for prolactinomas, surgery can be an excellent option and should be considered as an alternative primary treatment modality when patients are predicted to achieve a good surgical outcome.
Abstract
Purpose: Treatment with dopamine agonists (DAs) has been the first-line standard treatment for prolactinoma, and surgery has been reserved for drug intolerance and resistance for several decades. We evaluated whether surgery plays a primary role in pro lactinoma management. Materials and Methods: We conducted a retrospective study of 210 prolactinoma patients who had received surgical treatment at our institution. We analyzed the treatment outcomes according to tumor extent, sex, and preoperative DA medication. Results: Overall hormonal remission was achieved in 164 patients (78.1%), and complete removal was achieved in 194 patients (92.4%). When the tumors were completely removed, the remission rate increased to 84.5%. Anterior pituitary function was nor malized or improved in 94.6% of patients, whereas only 4.1% of patients showed worsening of hormone control. Hormonal remis sion was higher in patients who had not received DA preoperatively than in those who had received preoperative DA treatment. Smaller tumor size (<1 cm), no invasion into the cavernous sinus, and female sex were predictors of good surgical outcomes. Conclusion: Although DAs remain the first-line standard treatment for prolactinomas, surgery can be an excellent option and should be considered as an alternative primary treatment modality when patients are predicted to achieve a good surgical outcome.
참고문헌 (35)
- Gillam MP, "Advances in the treatment of prolactinomas", Endocr Rev, 27, pp.485~534 (2006)
- Barber TM, "Recurrence of hyperprolactinaemia following discontinuation of dopamine agonist therapy in patients with prolactinoma occurs commonly especially in macroprolactinoma", Clin Endocrinol(Oxf), 75, pp.819~824 (2011)
- Bevan JS, "Dopamine agonists and pituitary tumor shrinkage", Endocr Rev, 13, pp.220~240 (1992)
- Molitch ME, "Bromocriptine as primary therapy for prolactin-secreting macroadenomas : results of a prospective multicenter study", J Clin Endocrinol Metab, 60, pp.698~705 (1985)
- Webster J, "A comparison of cabergoline and bromocriptine in the treatment of hyperprolactinemic amenorrhea", N Engl J Med, 331, pp.904~909 (1994)
- Kars M, "Update in prolactinomas", Neth J Med, 68, pp.104~112 (2010)
- Herzog A, "Retroperitoneal fibrosis in a patient with macroprolactinoma treated with bromocriptine", BMJ, 298, pp.1315~ (1989)
- Serratrice J, "Fibrotic valvular heart disease subsequent to bromocriptine treatment", Cardiol Rev, 10, pp.334~336 (2002)
- Pinero A, "Cabergoline-related severe restrictive mitral regurgitation", N Engl J Med, 353, pp.1976~1977 (2005)
- Teixeira M, "Prolactinoma management : predictors of remission and recurrence after dopamine agonists withdrawal", Pituitary, 20, pp.464~470 (2017)
- Casanueva FF, "Guidelines of the Pituitary Society for the diagnosis and management of prolactinomas", Clin Endocrinol(Oxf), 65, pp.265~273 (2006)
- Melmed S, "Diagnosis and treatment of hyperprolactinemia : an Endocrine Society clinical practice guideline", J Clin Endocrinol Metab, 96, pp.273~288 (2011)
- Hu J, "Current drug withdrawal strategy in prolactinoma patients treated with cabergoline : a systematic review and meta-analysis", Pituitary, 18, pp.745~751 (2015)
- Xia MY, "Optimal timing of dopamine agonist withdrawal in patients with hyperprolactinemia : a systematic review and meta-analysis", Endocrine, 59, pp.50~61 (2018)
- Buchfelder M, "Surgical treatment of pituitary tumours", Best Pract Res Clin Endocrinol Metab, 23, pp.677~692 (2009)
- Buchfelder M, "The surgical treatment of acromegaly", Pituitary, 20, pp.76~83 (2017)
- Sinha S, "Microsurgical management of prolactinomas-clinical and hormonal outcome in a series of 172cases", Neurol India, 59, pp.532~536 (2011)
- Kreutzer J, "Operative treatment of prolactinomas : indications and results in a current consecutive series of 212 patients", Eur J Endocrinol, 158, pp.11~18 (2008)
- Babey M, "Pituitary surgery for small prolactinomas as an alternative to treatment with dopamine agonists", Pituitary, 14, pp.222~230 (2011)
- Lee EJ, "Tumor tissue identification in the pseudocapsule of pituitary adenoma: should the pseudocapsule be removed for total resection of pituitary adenoma?", Neurosurgery, 64(3 Suppl), pp.ONS62~ONS70 (2009)
- Kim EH, "Application of low-field intraoperative magnetic resonance imaging in transsphenoidal surgery for pituitary adenomas: technical points to improve the visibility of the tumor resection margin", Acta Neurochir(Wien), 155, pp.485~493 (2013)
- Junhyung Kim, "Clinical Significance of Radical Surgery in the Treatment of Silent Corticotroph Adenoma", 대한신경외과학회지, 62(1), pp.114~122 (2019), 대한신경외과학회[DOI]
- Oh MC, "Coexistence of intracranial aneurysm in 800 patients with surgically confirmed pituitary adenoma", J Neurosurg, 116, pp.942~947 (2012)
- Daly AF, "The epidemiology and genetics of pituitary adenomas", Best Pract Res Clin Endocrinol Metab, 23, pp.543~554 (2009)
- Molitch ME, "Pituitary tumours : pituitary incidentalomas", Best Pract Res Clin Endocrinol Metab, 23, pp.667~675 (2009)
- Maiter D, "Management of dopamine agonist-resistant prolactinoma", Neuroendocrinology, 109, pp.42~50 (2019)
- Tampourlou M, "Surgery in microprolactinomas : effectiveness and risks based on contemporary literature", Eur J Endocrinol, 175, pp.R89~R96 (2016)
- Kim D, "Prolactin ≤1 ng", mL predicts macroprolactinoma reduction after cabergoline therapy, 2020, pp.182, 177~183
- Salvatori R, "Surgical treatment of microprolactinomas : pros", Endocrine, 47, pp.725~729 (2014)
- Dekkers OM, "Recurrence of hyperprolactinemia after withdrawal of dopamine agonists : systematic review and meta-analysis", J Clin Endocrinol Metab, 95, pp.43~51 (2010)
- Honegger J, "Surgery for prolactinomas : a better choice?", Pituitary, 23, pp.45~51 (2020)
- Park YW, "Radiomics with ensemble machine learning predicts dopamine agonist response in patients with prolactinoma", J Clin Endocrinol Metab, 106, pp.e3069~e3077 (2021)
- Vroonen L, "Prolactinomas resistant to standard doses of cabergoline : a multicenter study of 92 patients", Eur J Endocrinol, 167, pp.651~662 (2012)
- Menucci M, "Effect of dopaminergic drug treatment on surgical findings in prolactinomas", Pituitary, 14, pp.68~74 (2011)
- Primeau V, "Outcomes of transsphenoidal surgery in prolactinomas : improvement of hormonal control in dopamine agonist-resistant patients", Eur J Endocrinol, 166, pp.779~786 (2012)