First-line surgery in prolactinomas: lessons from a long-term follow-up study in a tertiary referral center
| Autor: | Markus M. Luedi, Rolf W. Seiler, Robert H. Andres, Emanuel Christ, Marwan El-Koussy, H.R. Widmer, Jürgen Beck, Luigi Mariani, Lukas Andereggen, Janine Frey |
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| Rok vydání: | 2020 |
| Předmět: |
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medicine.medical_specialty Adenoma Long term follow up Endocrinology Diabetes and Metabolism Long Term Adverse Effects 030209 endocrinology & metabolism 610 Medicine & health Knosp grading 03 medical and health sciences 0302 clinical medicine Endocrinology Microprolactinoma Postoperative Complications medicine Clinical endpoint Humans Neoplasm Invasiveness Pituitary Neoplasms Prolactinoma Macroprolactinoma Macroadenoma Primary surgical therapy Hypophysectomy Duration of Therapy business.industry Patient Selection Retrospective cohort study Microadenoma Middle Aged medicine.disease Immunohistochemistry Long-term outcome Surgery Tumor Burden Dopamine agonists Referral center Cavernous Sinus Female Risk Adjustment Original Article business 030217 neurology & neurosurgery |
| Zdroj: | Journal of Endocrinological Investigation Andereggen, L.; Frey, J.; Andres, R. H.; Luedi, M. M.; El-Koussy, M.; Widmer, H. R.; Beck, J.; Mariani, L.; Seiler, R. W.; Christ, E. (2021). First-line surgery in prolactinomas: lessons from a long-term follow-up study in a tertiary referral center. Journal of endocrinological investigation, 44(12), pp. 2621-2633. Springer 10.1007/s40618-021-01569-6 |
| ISSN: | 1720-8386 |
| DOI: | 10.1007/s40618-021-01569-6 |
| Popis: | ContextAlthough consensus guidelines recommend dopamine agonists (DAs) as the first-line approach in prolactinomas, some patients may opt instead for upfront surgery, with the goal of minimizing the need for continuation of DAs over the long term. While this approach can be recommended in selected patients with a microprolactinoma, the indication for upfront surgery in macroprolactinomas remains controversial, with limited long-term data in large cohorts. We aimed at elucidating whether first-line surgery is equally safe and effective for patients with micro- or macroprolactinomas not extending beyond the median carotid line (i.e., Knosp grade ≤ 1).MethodologyRetrospective study of patients with prolactinomas Knosp grade ≤ 1 treated with upfront surgery. The primary endpoint was patients’ dependence on DAs at last follow-up. The secondary endpoint was postoperative complications. Independent risk factors for long-term dependence on DAs were analyzed.ResultsA microadenoma was noted in 45 patients (52%) and a macroadenoma in 41 (48%), with 17 (20%) harboring a Knosp grade 1 prolactinoma. Median follow-up was 80 months. First-line surgery resulted in long-term remission in 31 patients (72%) with a microprolactinoma and in 18 patients (45%) with a macroprolactinoma (p = 0.02). DA therapy was ultimately required in 11 patients (24%) with microadenomas vs. 20 (49%) with macroadenomas (p = 0.03). As for the latter, DA was required in 13 patients (76%) with Knosp grade 1 macroadenomas vs. 7 patients (29%) with Knosp grade 0 macroadenomas (p = 0.004). There was no mortality, and morbidity was minimal. Knosp grade 1 prolactinomas (OR 7.3, 95% CI 1.4–37.7,p = 0.02) but not adenoma size (i.e., macroprolactinomas) were an independent predictor of long-term dependence on DAs.ConclusionsFirst-line surgery in patients with microprolactinomas or macroprolactinomas Knosp grade 0 resulted in a good chance of non-dependency on DA therapy. However, in patients with prolactinomas Knosp grade 1, first-line surgery cannot be recommended, as adjuvant DA therapy after surgery is required in the majority of them over the long term. |
| Databáze: | OpenAIRE |
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