Efficacy and safety of endoscopic transsphenoidal resection for prolactinoma: a retrospective multicenter case-series

Zandbergen, I.M.; Huntoon, K.M.; White, T.G.; Bakker, L.E.H.; Verstegen, M.J.T.; Ghalib, L.M.; ... ; Prevedello, D.M. (2023)

Article / Letter to editor

Background: 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.Aims: To report on outcomes of ETSS in a cohort of prolactinomas.Methods: 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.Results: Median preoperative prolactin levels were 166 (98-837 mu g/L; males 996 [159-2145 mu g/L] vs. females 129 [84-223 mu g/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.Conclusions: 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.(c) 2023 Instituto Mexicano del Seguro Social (IMSS). Published by Elsevier Inc. All rights reserved.

• Prolactinoma
• Dopamine agonist
• Endoscopic trans-sphenoidal resection
• Efficacy
• safety
• Remission

• All authors: Zandbergen, I.M.; Huntoon, K.M.; White, T.G.; Bakker, L.E.H.; Verstegen, M.J.T.; Ghalib, L.M.; Furth, W.R.V.; Pelsma, I.C.M.; Dehdashti, A.R.; Biermasz, N.R.; Prevedello, D.M.
• Date: 2023-12-16
• Journal: Archives of Medical Research
• Volume: 54
• Issue: 8
• DOI: doi:10.1016/j.arcmed.2023.102919
• Link: https://www.sciencedirect.com/science/article/pii/S0188440923001571?via%...