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Endocrine

, Volume 55, Issue 1, pp 223–230 | Cite as

10-year follow-up study comparing primary medical vs. surgical therapy in women with prolactinomas

  • Lukas Andereggen
  • Janine Frey
  • Robert H. Andres
  • Marwan El-Koussy
  • Jürgen Beck
  • Rolf W. Seiler
  • Emanuel ChristEmail author
Original Article

Abstract

While dopamine-agonists are the first-line approach in treating prolactinomas, surgery can be considered in selected cases besides non-responders or patients with dopamine-agonist intolerance. The aim of the present study was to compare the long-term outcome in women with prolactinomas treated primarily either surgically or medically who had not had prior dopamine-agonist treatment. Retrospective case-note study of all consecutive women with prolactinomas primarily managed with medical therapy or surgery in a tertiary referral centre. The clinical, biochemical, and radiological responses to first-line treatment at early and long-term follow-up were analysed. The primary therapeutic strategy was dopamine-agonists for 36 (34 %) and surgery for 71 (66 %) of the women. Baseline clinical and biochemical characteristics were not significantly different between the primary surgical and medical cohort. Median follow-up time was 90 months (range 13–408). Following primary treatment, prolactin level significantly decreased in both cohorts, on average to 13.5 µg/L (IQR 7–21; p < 0.001), and was within the normal range in 82 % of all patients. No women in the surgical cohort demonstrated permanent sequelae and morbidity was low. At final follow-up, control of hyperprolactinaemia required dopamine-agonist therapy in 64 % of women who had undergone primary medical therapy vs. 32 % of those who had primary surgical therapy (p = 0.003). Logistic regression revealed that the primary therapeutic strategy, but not adenoma size, was an independent risk factor for long-term dependence on dopamine-agonists. The present data indicate that in a dedicated tertiary referral centre, long-term control of hyperprolactinaemia in women with prolactinomas is high. In selected cases, a primary neurosurgical approach might at least be interdisciplinarily discussed with the primary goal of minimizing long-term dependence on dopamine-agonists.

Keywords

Long-term results Primary medical therapy Primary surgical therapy Prolactinoma Women 

Notes

Acknowledgments

We are grateful for the support of the Swiss National Science Foundation (PBBEB-146099, and -155299 to L.A.). We wish to thank Dr. Edward R. Laws, Jr., MD, FACS, Director, Pituitary and Neuroendocrine Centre, Brigham & Women’s Hospital, Boston, for his insightful suggestions. The assistance of Ms. Susan Kaplan in editing the manuscript is acknowledged.

Compliance with ethical standards

Competing interests

This work or part of this work has not been previously published and/or is not under consideration for publication anywhere else. The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Ethical standards and patient consent

This study was approved by the Ethical Committee of Bern (Kantonale Ethikkommision, KEK, Bern, Switzerland), the Swiss Ethics Committee on research involving humans. The study was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Supplementary material

12020_2016_1115_MOESM1_ESM.docx (42 kb)
Supplementary Information

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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Lukas Andereggen
    • 1
  • Janine Frey
    • 2
  • Robert H. Andres
    • 1
  • Marwan El-Koussy
    • 3
  • Jürgen Beck
    • 1
  • Rolf W. Seiler
    • 1
  • Emanuel Christ
    • 2
    Email author
  1. 1.Departments of NeurosurgeryBern University Hospital, University of BernBernSwitzerland
  2. 2.Endocrinology Diabetes and MetabolismBern University Hospital, University of BernBernSwitzerland
  3. 3.Neuroradiology, InselspitalBern University Hospital, University of BernBernSwitzerland

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