Cure and Hormonal Control After Prolactinoma Resection: Case Series and Systematic Review

• Published in: Journal of the Endocrine Society 2021-10, Vol.5 (10), p.bvab074-bvab074
• Main Authors: Penn, Marisa C, Cardinal, Tyler, Zhang, Yanchen, Abt, Brittany, Bonney, Phillip A, Lorenzo, Patricia, Lin, Michelle, Rosner, Jack, Weiss, Martin, Zada, Gabriel, Carmichael, John D
• Format: Article
• Language: English
• Subjects: Clinical; Prolactin; Surgery
• ISSN: 2472-1972; 2472-1972
• DOI: 10.1210/jendso/bvab074

Abstract 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 (