Surgical treatment of prolactinomas - our experience [Prolaktinomi - kirurško ili medikamentozno liječenje?]

Gnjidić, Živko and Kudelić, Nenad and Sajko, Tomislav and Malenica, Maša and Stipić, Darko and Rotim, Krešimir (2014) Surgical treatment of prolactinomas - our experience [Prolaktinomi - kirurško ili medikamentozno liječenje?]. Collegium Antropologicum, 38 (2). pp. 571-576. ISSN 0350-6134

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Abstract

The dilemma of whether to apply surgical or drug treatment to prolactinomas has been ongoing for the past 30 years. The aim of this study is to compare the early postoperative values of prolactin (PRL) in two groups of patients with prolactinomas: those who underwent primary surgical-treatment, and those who underwent surgery after a dopamine agonist (DA) therapy. We present the results of surgical treatment on a series of 161 patients with prolactinomas. Surgery was the primary treatment in 65 patients, while 96 patients had surgery following a long-term treatment with a DA. All surgically treated prolactinomas were operated in the standard transsphenoidal, microsurgical approach. The criteria for hyperprolactinemia remission was a PRL level under 25 ng/ml. Early normalization of PRL was achieved in 92% of those patients who underwent primary surgical-treatment, yet it was achieved in only 42% of patients who were operated on after receiving a long-term drug treatment with a DA. The highest prevalence of postoperative normalization of PRL was achieved in a group of patients with microadenomas who were primarily operated on (98%). The worst results in postoperative normalization of PRL were found in the group of patients with macroadenomas who received a long-term drug treatment with a DA first. These results show our surgical experience in treating prolactinomas. Using surgical treatment, the best clinical outcome was achieved with microprolactinomas and intrasellar, well-confined macroprolactinomas. Nevertheless, we stress the need of an individualized approach and recommend treatment in multidisciplinary centres for pituitary diseases.

Abstract in Croatian

Dilema, operirati ili medikamentozno liječiti prolaktinome prisutna je već 30 godina. Cilj ovog istraživanja je usporediti normalizaciju ranih postoperativnih vrijednosti prolaktina (PRL) u dvije skupine bolesnika sa prolaktinomima: primarno kirurški liječenih i onih koji su kirurški liječeni nakon prethodne terapije agonistima dopamina (DA). U ovom članku prezentirani su rezultati operacijskog liječenja 161 bolesnika s prolaktinomom. Operacija je bila primarni način liječenja u 65 bolesnika, dok je 96 bolesnika operirano nakon dugotrajne medikamentozne terapije s DA. Svi kirurški tretirani prolaktinomi operirani su standardnim, transsfenoidalnim, mikrokirurškim pristupom od strane jednog operatera. Kao definiciju remisije hiperprolaktinemije koristili smo normalizaciju koncentracije bazalnih vrijednosti prolaktina (PRL) ispod 25 ng/mL. U primarno operiranih bolesnika postignuta je rana postoperativna normalizacija PRL u 92% slučajeva, a u operiranih nakon dugotrajne medikamentozne terapije sa DA u samo 42% slučajeva. Najbolje rezultate u normalizaciji koncentracije prolaktina postigli smo u skupini bolesnika sa mikroadenomima koji su primarno operirani (98%), a najlošije rezultate u skupini bolesnika s makroadenomima koji su prethodno bili na dugotrajnoj medikamentoznoj terapiji s DA (17,3%). Ovi rezultati prikazuju naše iskustvo u kiruškom liječenju prolaktinoma. Najbolji klinički rezultat imali smo sa mikroprolaktinomima i intraselarnim, dobro ograničenim makroprolaktinomima. Ističemo potrebu multidisciplinarnog i individualnog pristupa u izboru metode liječenja.

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