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Surgical treatment of microprolactinomas: pros

  • Pros and Cons in Endocrine Practice
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Abstract

Medical therapy with dopaminergic agonists (DAs) has been used for several decades for the treatment of both micro- and macroprolactinomas, without much differentiation between the two conditions. While most cases respond well to DAs in terms of prolactin normalization and control of tumor growth, DAs are often needed for many years, or even for lifetime. Concerns have been raised recently about the possible side effects of long-term use of these medications on the anatomy and function of the heart valves. While macroprolactinomas are rarely surgically curable, pituitary surgery in expert hands is a safe and effective method to permanently cure microprolactinomas, with long-term cure rates around 70 %. In this article, I will review the data on safety of DAs an on the effectiveness and safety of surgery, and I will make an argument that surgery should be offered as a possible therapy to microprolactinoma patients, provided that an experienced pituitary neurosurgeon is available.

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References

  1. A. Fernandez, N. Karavitaki, J.A. Wass, Prevalence of pituitary adenomas: a community-based, cross-sectional study in Banbury (Oxfordshire, UK). Clin. Endocrinol. (Oxf) 72, 377–382 (2010)

    Article  Google Scholar 

  2. C.L. Boguszewski, C.M. dos Santos, K.S. Sakamoto, L.C. Marini, A.M. de Souza, M. Azevedo, A comparison of cabergoline and bromocriptine on the risk of valvular heart disease in patients with prolactinomas. Pituitary 15, 44–49 (2012)

    Article  CAS  PubMed  Google Scholar 

  3. S. Melmed, F.F. Casanueva, A.R. Hoffman, D.L. Kleinberg, V.M. Montori, J.A. Schlechte, J.A. Wass, Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline. J. Clin. Endocrinol. Metab. 96, 273–288 (2011)

    Article  CAS  PubMed  Google Scholar 

  4. F.F. Casanueva, M.E. Molitch, J.A. Schlechte, R. Abs, V. Bonert, M.D. Bronstein, T. Brue, P. Cappabianca, A. Colao, R. Fahlbusch, H. Fideleff, M. Hadani, P. Kelly, D. Kleinberg, E. Laws, J. Marek, M. Scanlon, L.G. Sobrinho, J.A. Wass, A. Giustina, Guidelines of the Pituitary Society for the diagnosis and management of prolactinomas. Clin. Endocrinol. (Oxf) 65, 265–273 (2006)

    Article  Google Scholar 

  5. A. Klibanski, Clinical practice prolactinomas. N. Engl. J. Med. 362, 1219–1226 (2010)

    Article  CAS  PubMed  Google Scholar 

  6. B.M. Biller, A. Colao, S. Petersenn, V.S. Bonert, M. Boscaro, Prolactinomas, Cushing’s disease and acromegaly: debating the role of medical therapy for secretory pituitary adenomas. BMC Endocr. Disord. 10, 10 (2010)

    Article  PubMed Central  PubMed  Google Scholar 

  7. S. Sinha, B.S. Sharma, A.K. Mahapatra, Microsurgical management of prolactinomas—clinical and hormonal outcome in a series of 172 cases. Neurol. India 59, 532–536 (2011)

    Article  PubMed  Google Scholar 

  8. J. Verhelst, R. Abs, D. Maiter, A. van den Bruel, M. Vandeweghe, B. Velkeniers, J. Mockel, G. Lamberigts, P. Petrossians, P. Coremans, C. Mahler, A. Stevenaert, J. Verlooy, C. Raftopoulos, A. Beckers, Cabergoline in the treatment of hyperprolactinemia: a study in 455 patients. J. Clin. Endocrinol. Metab. 84, 2518–2522 (1999)

    Article  CAS  PubMed  Google Scholar 

  9. A.T. Wang, R.J. Mullan, M.A. Lane, A. Hazem, C. Prasad, N.W. Gathaiya, M.M. Fernandez-Balsells, A. Bagatto, F. Coto-Yglesias, J. Carey, T.A. Elraiyah, P.J. Erwin, G.Y. Gandhi, V.M. Montori, M.H. Murad, Treatment of hyperprolactinemia: a systematic review and meta-analysis. Syst. Rev. 1, 33 (2012)

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  10. S.C. Chang, C.H. Chen, M.L. Lu, Cabergoline-induced psychotic exacerbation in schizophrenic patients. Gen. Hosp. Psychiatry 30, 378–380 (2008)

    Article  PubMed  Google Scholar 

  11. J. Martinkova, L. Trejbalova, M. Sasikova, J. Benetin, P. Valkovic, Impulse control disorders associated with dopaminergic medication in patients with pituitary adenomas. Clin. Neuropharmacol. 34, 179–181 (2011)

    Article  CAS  PubMed  Google Scholar 

  12. R. Schade, F. Andersohn, S. Suissa, W. Haverkamp, E. Garbe, Dopamine agonists and the risk of cardiac-valve regurgitation. N. Engl. J. Med. 356, 29–38 (2007)

    Article  CAS  PubMed  Google Scholar 

  13. R. Zanettini, A. Antonini, G. Gatto, R. Gentile, S. Tesei, G. Pezzoli, Valvular heart disease and the use of dopamine agonists for Parkinson’s disease. N. Engl. J. Med. 356, 39–46 (2007)

    Article  CAS  PubMed  Google Scholar 

  14. B.L. Roth, Drugs and valvular heart disease. N. Engl. J. Med. 356, 6–9 (2007)

    Article  CAS  PubMed  Google Scholar 

  15. E. Valassi, A. Klibanski, B.M. Biller, Clinical review: potential cardiac valve effects of dopamine agonists in hyperprolactinemia. J. Clin. Endocrinol. Metab. 95, 1025–1033 (2010)

    Article  CAS  PubMed  Google Scholar 

  16. A. Drake, C.E. Stiles, T.A. Howlett, A.A. Toogood, J.S. Bevan, R.P. Steeds, UK Dopamine Agonist Valvulopathy Group, A cross-sectional study of the prevalence of cardiac valvular abnormalities in hyperprolactinemic patients treated with ergot-derived dopamine agonists. J. Clin. Endocrinol. Metab. 99, 90–96 (2014)

    Article  CAS  PubMed  Google Scholar 

  17. J. Serratrice, P. Disdier, G. Habib, F. Viallet, P.J. Weiller, Fibrotic valvular heart disease subsequent to bromocriptine treatment. Cardiol. Rev. 10, 334–336 (2002)

    Article  PubMed  Google Scholar 

  18. A. Elenkova, R. Shabani, K. Kalinov, S. Zacharieva, Increased prevalence of subclinical cardiac valve fibrosis in patients with prolactinomas on long-term bromocriptine and cabergoline treatment. Eur. J. Endocrinol. 167, 17–25 (2012)

    Article  CAS  PubMed  Google Scholar 

  19. A. Colao, A. Di Sarno, P. Cappabianca, C. Di Somma, R. Pivonello, G. Lombardi, Withdrawal of long-term cabergoline therapy for tumoral and nontumoral hyperprolactinemia. N. Engl. J. Med. 349, 2023–2033 (2003)

    Article  CAS  PubMed  Google Scholar 

  20. J. Kharlip, R. Salvatori, G. Yenokyan, G.S. Wand, Recurrence of hyperprolactinemia after withdrawal of long-term cabergoline therapy. J. Clin. Endocrinol. Metab. 94, 2428–2436 (2009)

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  21. O.M. Dekkers, J. Lagro, P. Burman, J.O. Jorgensen, J.A. Romijn, A.M. Pereira, Recurrence of hyperprolactinemia after withdrawal of dopamine agonists: systematic review and meta-analysis. J. Clin. Endocrinol. Metab. 95, 43–51 (2010)

    Article  CAS  PubMed  Google Scholar 

  22. A.M. Pereira, Update on the withdrawal of dopamine agonists in patients with hyperprolactinemia. Curr. Opin. Endocrinol. Diabetes Obes. 18, 264–268 (2011)

    Article  CAS  PubMed  Google Scholar 

  23. R. Kwancharoen, R.S. Auriemma, G. Yenokyan, G.S. Wand, A. Colao, R. Salvatori, Second attempt to withdraw cabergoline in prolactinomas: a pilot study. Pituitary (2013). doi:10.1007/s11102-013-0525-x

  24. S.M. Joshi, S. Cudlip, Transsphenoidal surgery. Pituitary 11, 353–360 (2008)

    Article  PubMed  Google Scholar 

  25. J.A. Jane Jr, R.M. Starke, M.A. Elzoghby, D.L. Reames, S.C. Payne, M.O. Thorner, J.C. Marshall, E.R. Laws Jr, M.L. Vance, Endoscopic transsphenoidal surgery for acromegaly: remission using modern criteria, complications, and predictors of outcome. J. Clin. Endocrinol. Metab. 96, 2732–2740 (2011)

    Article  CAS  PubMed  Google Scholar 

  26. P. Nomikos, M. Buchfelder, R. Fahlbusch, The outcome of surgery in 668 patients with acromegaly using current criteria of biochemical ‘cure’. Eur. J. Endocrinol. 152, 379–387 (2005)

    Article  CAS  PubMed  Google Scholar 

  27. R.S. Jallad, M.D. Bronstein, Optimizing medical therapy of acromegaly: beneficial effects of cabergoline in patients uncontrolled with long-acting release octreotide. Neuroendocrinology 90, 82–92 (2009)

    Article  CAS  PubMed  Google Scholar 

  28. M. Marazuela, A. Ramos-Leví, M. Sampedro-Núñez, I. Bernabeu, Cabergoline treatment in acromegaly: pros. Endocrine (2014). doi:10.1007/s12020-014-0206-1

  29. L. Kasuki, L. Vieira Neto, M.R. Gadelha, Cabergoline treatment in acromegaly: cons. Endocrine (2014). doi:10.1007/s12020-014-0183-4

  30. J. Kreutzer, R. Buslei, H. Wallaschofski, B. Hofmann, C. Nimsky, R. Fahlbusch, M. Buchfelder, Operative treatment of prolactinomas: indications and results in a current consecutive series of 212 patients. Eur. J. Endocrinol. 158, 11–18 (2008)

    Article  CAS  PubMed  Google Scholar 

  31. M. Babey, R. Sahli, I. Vajtai, R.H. Andres, R.W. Seiler, Pituitary surgery for small prolactinomas as an alternative to treatment with dopamine agonists. Pituitary 14, 222–230 (2011)

    Article  PubMed Central  PubMed  Google Scholar 

  32. X. Qu, M. Wang, G. Wang, T. Han, C. Mou, L. Han, M. Jiang, Y. Qu, M. Zhang, Q. Pang, G. Xu, Surgical outcomes and prognostic factors of transsphenoidal surgery for prolactinoma in men: a single-center experience with 87 consecutive cases. Eur. J. Endocrinol. 164, 499–504 (2011)

    Article  CAS  PubMed  Google Scholar 

  33. A. Tamasauskas, K. Sinkunas, A. Bunevicius, A. Radziunas, D. Skiriute, V.P. Deltuva, Transsphenoidal surgery for microprolactinomas in women: results and prognosis. Acta Neurochir. (Wien) 154, 1889–1893 (2012)

    Article  Google Scholar 

  34. G. Raverot, A. Wierinckx, E. Dantony, C. Auger, G. Chapas, L. Villeneuve, T. Brue, D. Figarella-Branger, P. Roy, E. Jouanneau, M. Jan, J. Lachuer, J. Trouillas, Prognostic factors in prolactin pituitary tumors: clinical, histological, and molecular data from a series of 94 patients with a long postoperative follow-up. J. Clin. Endocrinol. Metab. 95, 1708–1716 (2010)

    Article  CAS  PubMed  Google Scholar 

  35. V. Primeau, C. Raftopoulos, D. Maiter, Outcomes of transsphenoidal surgery in prolactinomas: improvement of hormonal control in dopamine agonist-resistant patients. Eur. J. Endocrinol. 166, 779–786 (2012)

    Article  CAS  PubMed  Google Scholar 

  36. M. Loyo-Varela, T. Herrada-Pineda, F. Revilla-Pacheco, S. Manrique-Guzman, Pituitary tumor surgery: review of 3,004 cases. World Neurosurg. 79, 331–336 (2013)

    Article  PubMed  Google Scholar 

  37. S. Berkmann, J. Fandino, B. Muller, K.F. Kothbauer, C. Henzen, H. Landolt, Pituitary surgery: experience from a large network in Central Switzerland. Swiss Med. Wkly. 142, w13680 (2012)

    PubMed  Google Scholar 

  38. J.B. Tyrrell, K.R. Lamborn, L.T. Hannegan, C.B. Applebury, C.B. Wilson, Transsphenoidal microsurgical therapy of prolactinomas: initial outcomes and long-term results. Neurosurgery 44, 254–261 (1999)

    Article  CAS  PubMed  Google Scholar 

  39. E.F. Rodman, M.E. Molitch, K.D. Post, B.J. Biller, S. Reichlin, Long-term follow-up of transsphenoidal selective adenomectomy for prolactinoma. J. Am. Med. Assoc. 252, 921–924 (1984)

    Article  CAS  Google Scholar 

  40. K.D. Post, J.E. Habas, Comparison of long term results between prolactin secreting adenomas and ACTH secreting adenomas. Can. J. Neurol. Sci. 17, 74–77 (1990)

    CAS  PubMed  Google Scholar 

  41. J.A. Thomson, C.E. Gray, G.M. Teasdale, Relapse of hyperprolactinemia after transsphenoidal surgery for microprolactinoma: lessons from long-term follow-up. Neurosurgery 50, 36–39 (2002)

    PubMed  Google Scholar 

  42. S. Ahmed, M. Elsheikh, I.M. Stratton, R.C. Page, C.B. Adams, J.A. Wass, Outcome of transsphenoidal surgery for acromegaly and its relationship to surgical experience. Clin. Endocrinol. (Oxf) 50, 561–567 (1999)

    Article  CAS  Google Scholar 

  43. E. Erturk, L.E. Tunce, S. Kiyici, C. Ersoy, C. Duran, S. Imamoglu, Outcome of surgery for acromegaly performed by different surgeons: importance of surgical experience. Pituitary 8, 93–97 (2005)

    Article  PubMed  Google Scholar 

  44. A.R. Bokhari, M.A. Davies, T. Diamond, Endoscopic transsphenoidal pituitary surgery: a single surgeon experience and the learning curve. Br. J. Neurosurg. 27, 44–49 (2013)

    Article  PubMed  Google Scholar 

  45. I. Ciric, A. Ragin, C. Baumgartner, D. Pierce, Complications of transsphenoidal surgery: results of a national survey, review of the literature, and personal experience. Neurosurgery 40, 225–236 (1997)

    Article  CAS  PubMed  Google Scholar 

  46. F.G. Barker, A. Klibanski, B. Swearingen, Transsphenoidal surgery for pituitary tumors in the United States, 1996–2000: mortality, morbidity, and the effects of hospital and surgeon volume. J. Clin. Endocrinol. Metab. 88, 4709–4719 (2003)

    Article  CAS  PubMed  Google Scholar 

  47. R.M. Starke, D.L. Reames, C.J. Chen, E.R. Laws, J.A. Jane Jr, Endoscopic transsphenoidal surgery for Cushing disease: techniques, outcomes, and predictors of remission. Neurosurgery 72, 240–247 (2013)

    Article  PubMed  Google Scholar 

  48. A. Abosch, J.B. Tyrrell, K.R. Lamborn, L.T. Hannegan, C.B. Applebury, C.B. Wilson, Transsphenoidal microsurgery for growth hormone-secreting pituitary adenomas: initial outcome and long-term results. J. Clin. Endocrinol. Metab. 83, 3411–3418 (1998)

    Article  CAS  PubMed  Google Scholar 

  49. M. Menucci, A. Quinones-Hinojosa, P. Burger, R. Salvatori, Effect of dopaminergic drug treatment on surgical findings in prolactinomas. Pituitary 14, 68–74 (2011)

    Article  CAS  PubMed  Google Scholar 

  50. N. McLaughlin, E.R. Laws, N.M. Oyesiku, L. Katznelson, D.F. Kelly, Pituitary centers of excellence. Neurosurgery 71, 916–924 (2012)

    Article  PubMed  Google Scholar 

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  1. Division of Endocrinology, Diabetes and Metabolism, and Pituitary Center, Department of Medicine, The Johns Hopkins University School of Medicine, 1830 East Monument Street #333, Baltimore, MD, 21287, USA

    Roberto Salvatori

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Correspondence to Roberto Salvatori.

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Salvatori, R. Surgical treatment of microprolactinomas: pros. Endocrine 47, 725–729 (2014). https://doi.org/10.1007/s12020-014-0281-3

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