Pituitary surgery as alternative to dopamine agonists treatment for microprolactinomas: a cohort study

in European Journal of Endocrinology
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  • 1 Department of Neurosurgery, Foch Hospital, Suresnes, France
  • | 2 INSERM U1016, Institut Cochin, 75014 Paris, France; CNRS UMR 8104, 75014 Paris, France; Université Paris Descartes-Université de Paris, 75006 Paris, France
  • | 3 Department of Pathological Cytology and Anatomy, Foch Hospital, Suresnes, France
  • | 4 Department of Endocrinology, Liège, Belgium
  • | 5 Institut Curie, INSERM U900, MINES ParisTech, PSL-Research University, CBIO-Centre for Computational Biology, Paris, France
  • | 6 Department of Endocrinology, Hôpital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, Boulogne Billancourt, France
  • | 7 UE4340, Université de Versailles Saint-Quentin-en-Yvelines Montigny-le-Bretonneux, Versailles, France
  • | 8 Department of Endocrinology, Foch Hospital, Suresnes, France
  • | 9 Hormonal Biology Laboratory, Assistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, France
  • | 10 Department of Radiology, Hôpital Cochin, AP-HP, Paris, France
  • | 11 Université de Paris, Paris, France
  • | 12 Department of Endocrinology, Center for Rare Adrenal Diseases, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Paris, France

Correspondence should be addressed to B Baussart; Email: bertranbaussart@gmail.com

*(G Assié and S Gaillard contributed equally as senior authors)

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Objective

Microprolactinomas are currently treated with dopamine agonists. Outcome information on microprolactinoma patients treated by surgery is limited. This study reports the first large series of consecutive non-invasive microprolactinoma patients treated by pituitary surgery and evaluates the efficiency and safety of this treatment.

Design

Follow-up of a cohort of consecutive patients treated by surgery.

Methods

Between January 2008 and October 2020, 114 adult patients with pure microprolactinomas were operated on in a single tertiary expert neurosurgical department, using an endoscopic endonasal transsphenoidal approach. Eligible patients presented with a microprolactinoma with no obvious cavernous invasion on MRI. Prolactin was assayed before and after surgery. Disease-free survival was modeled using Kaplan–Meier representation. A cox regression model was used to predict remission.

Results

Median follow-up was 18.2 months (range: 2.8–155). In this cohort, 14/114 (12%) patients were not cured by surgery, including ten early surgical failures and four late relapses occurring 37.4 months (33–41.8) after surgery. From Kaplan–Meier estimates, 1-year and 5-year disease free survival was 90.9% (95% CI: 85.6–96.4%) and 81% (95% CI: 71.2–92.1%) respectively. The preoperative prolactinemia was the only significant preoperative predictive factor for remission (P < 0.05). No severe complication was reported, with no anterior pituitary deficiency after surgery, one diabetes insipidus, and one postoperative cerebrospinal fluid leakage properly treated by muscle plasty.

Conclusions

In well-selected microprolactinoma patients, pituitary surgery performed by an expert neurosurgical team is a valid first-line alternative treatment to dopamine agonists.

Supplementary Materials

    • Supplemental Figure 1

 

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