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Efficacy and Safety of Endoscopic Transsphenoidal Resection for Prolactinoma: A Retrospective Multicenter Case-series

Archives of Medical Research, ISSN: 0188-4409, Vol: 54, Issue: 8, Page: 102919
2023
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Article Description

Endoscopic transsphenoidal surgery (ETSS) for prolactinoma is reserved for dopamine agonist (DA) resistance, intolerance, or apoplexy. High remission (overall 67%, microprolactinoma up to 90%), low recurrence (5–20%) rates highlighted that surgery might be first-line treatment. To report on outcomes of ETSS in a cohort of prolactinomas. Multicenter retrospective cohort of 137 prolactinoma patients (age 38.2 ± 13.7 years; 61.3% female, median follow-up 28.0 [15.0–55.5] months) operated between 2010–2019 with histopathological confirmation. Median preoperative prolactin levels were 166 (98–837 µg/L; males 996 [159–2145 µg/L] vs. females 129 [84–223 µg/L], p <0.001). 56 (40.9%) microprolactinomas, 69 (50.4%) macroprolactinomas, and 7 (5.1%) giant prolactinomas were included, whereas no adenoma was detected in 5 (3.6%) patients. Males had larger tumors (macroprolactinomas: 38, 71.7%) vs. 31 (36.9%), p <0.001; giant prolactinomas: 7 (13.2%) vs. 0 (0.0%), ( p <0.001). Prolactinomas were graded as KNOSP-3 in 15 (11.5%), and KNOSP-4 in 20 (15.3%) patients. Primary indication was DA intolerance (59, 43.1%); males 14 (26.4%) vs. females 45 (53.6%), p  = 0.006. Long-term remission (i.e., DA-free prolactin level <1xULN) was achieved in 87 (63.5%) patients, being higher in intended complete resection (69/92 [75.0%]), and lower in males (25 [47.2%] vs. 62 females [73.8%], p  = 0.002). Transient DI ( n  = 29, 21.2%) was the most frequent complication. Despite high proportions of macroprolactinoma and KNOSP 3–4, long-term remission rates were 63.5% overall, and 83.3% in microprolactinoma patients. Males had less favorable remission rate compared to females. These findings highlight that ETSS may be a safe and efficacious treatment to manage prolactinoma.

Bibliographic Details

Zandbergen, Ingrid Marijke; Huntoon, Kristin Michelle; White, Timothy G; Bakker, Leontine Erica Henriëtte; Verstegen, Marco Johanna Theodorus; Ghalib, Luma Mudhafar; van Furth, Wouter Ralph; Pelsma, Iris Catharina Maria; Dehdashti, Amir R; Biermasz, Nienke Ruurdje; Prevedello, Daniel M

Elsevier BV

Medicine

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