Advertisement

Transsphenoidal Surgery for Prolactinomas

  • Won KimEmail author
  • Srinivas Chivukula
  • Anthony Heaney
  • Marilene Wang
  • Marvin Bergsneider
Chapter

Abstract

Dopamine agonist therapy is considered first-line treatment for the great majority of prolactinomas. Although highly effective in normalizing serum prolactin levels and reducing tumor size, in clinical practice, a significant proportion of patients may ultimately choose transsphenoidal surgery. Indications include dopamine agonist resistance, intolerance as a result of side effects or adverse reactions, severe apoplexy, cerebrospinal fluid leak, and patient preference. In all cases, the goal is cure: in terms of both tumor resection and restoration of endocrine function. Patient selection is paramount to achieving this goal. Patients with localized tumor without extension outside the sella or into neighboring structures have been shown to have greater rates of normoprolactinemia following surgical extirpation. Moreover, those that are treated at dedicated pituitary centers by surgeons that specialize in pituitary surgery also enjoy greater rates of remission following operative treatment. Closer consideration of the surgical prolactinoma population as a heterogeneous patient set with individual tumor and patient characteristics that may prognosticate who will respond best to transsphenoidal surgery will aid patient counseling and surgical decision making in the future.

Keywords

Prolactinoma Surgery Operative Indications Prognostic Indicators 

Supplementary material

Video 26.1

Surgical demonstration of pseudocapsular resection technique for an endoscopic, endonasal resection of a prolactin-secreting macroadenoma (MOV 220657 kb)

References

  1. 1.
    Ciccarelli A, Daly AF, Beckers A. The epidemiology of prolactinomas. Pituitary. 2005;8(1):3–6. doi: 10.1007/s11102-005-5079-0.PubMedCrossRefGoogle Scholar
  2. 2.
    Daly AF, Tichomirowa MA, Beckers A. The epidemiology and genetics of pituitary adenomas. Best Pract Res Clin Endocrinol Metab. 2009;23(5):543–54. doi: 10.1016/j.beem.2009.05.008.PubMedCrossRefGoogle Scholar
  3. 3.
    Colao A, Lombardi G. Growth-hormone and prolactin excess. Lancet. 1998;352(9138):1455–61. doi: 10.1016/S0140-6736(98)03356-X.PubMedCrossRefGoogle Scholar
  4. 4.
    Casanueva FF, Molitch ME, Schlechte JA, Abs R, Bonert V, Bronstein MD, Brue T, Cappabianca P, Colao A, Fahlbusch R, Fideleff H, Hadani M, Kelly P, Kleinberg D, Laws E, Marek J, Scanlon M, Sobrinho LG, Wass JA, Giustina A. Guidelines of the pituitary Society for the diagnosis and management of prolactinomas. Clin Endocrinol. 2006;65(2):265–73. doi: 10.1111/j.1365-2265.2006.02562.x.CrossRefGoogle Scholar
  5. 5.
    Melmed S, Casanueva FF, Hoffman AR, Kleinberg DL, Montori VM, Schlechte JA, Wass JA, Endocrine S. Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96(2):273–88. doi: 10.1210/jc.2010-1692.PubMedCrossRefGoogle Scholar
  6. 6.
    Vasilev V, Daly AF, Vroonen L, Zacharieva S, Beckers A. Resistant prolactinomas. J Endocrinol Investig. 2011;34(4):312–6. doi: 10.3275/760410.1007/BF03347092.CrossRefGoogle Scholar
  7. 7.
    Webster J, Piscitelli G, Polli A, Ferrari CI, Ismail I, Scanlon MF. A comparison of cabergoline and bromocriptine in the treatment of hyperprolactinemic amenorrhea. Cabergoline comparative study group. N Engl J Med. 1994;331(14):904–9. doi: 10.1056/NEJM199410063311403.PubMedCrossRefGoogle Scholar
  8. 8.
    Molitch ME. Pharmacologic resistance in prolactinoma patients. Pituitary. 2005;8(1):43–52. doi: 10.1007/s11102-005-5085-2.PubMedCrossRefGoogle Scholar
  9. 9.
    Ono M, Miki N, Kawamata T, Makino R, Amano K, Seki T, Kubo O, Hori T, Takano K. Prospective study of high-dose cabergoline treatment of prolactinomas in 150 patients. J Clin Endocrinol Metab. 2008;93(12):4721–7. doi: 10.1210/jc.2007-2758.PubMedCrossRefGoogle Scholar
  10. 10.
    Molitch ME. Dopamine resistance of prolactinomas. Pituitary. 2003;6(1):19–27.PubMedCrossRefGoogle Scholar
  11. 11.
    Colao A, Di Sarno A, Landi ML, Scavuzzo F, Cappabianca P, Pivonello R, Volpe R, Di Salle F, Cirillo S, Annunziato L, Lombardi G. Macroprolactinoma shrinkage during cabergoline treatment is greater in naive patients than in patients pretreated with other dopamine agonists: a prospective study in 110 patients. J Clin Endocrinol Metab. 2000;85(6):2247–52. doi: 10.1210/jcem.85.6.6657.PubMedGoogle Scholar
  12. 12.
    Colao A. Pituitary tumours: the prolactinoma. Best Pract Res Clin Endocrinol Metab. 2009;23(5):575–96. doi: 10.1016/j.beem.2009.05.003.PubMedCrossRefGoogle Scholar
  13. 13.
    Hamilton DK, Vance ML, Boulos PT, Laws ER. Surgical outcomes in hyporesponsive prolactinomas: analysis of patients with resistance or intolerance to dopamine agonists. Pituitary. 2005;8(1):53–60. doi: 10.1007/s11102-005-5086-1.PubMedCrossRefGoogle Scholar
  14. 14.
    Molitch ME. Management of medically refractory prolactinoma. J Neuro-Oncol. 2014;117(3):421–8. doi: 10.1007/s11060-013-1270-8.CrossRefGoogle Scholar
  15. 15.
    Bloomgarden E, Molitch ME. Surgical treatment of prolactinomas: cons. Endocrine. 2014;47(3):730–3. doi: 10.1007/s12020-014-0369-9.PubMedCrossRefGoogle Scholar
  16. 16.
    Ikeda H, Watanabe K, Tominaga T, Yoshimoto T. Transsphenoidal microsurgical results of female patients with prolactinomas. Clin Neurol Neurosurg. 2013;115(9):1621–5. doi: 10.1016/j.clineuro.2013.02.016.PubMedCrossRefGoogle Scholar
  17. 17.
    Randall RV, Scheithauer BW, Laws Jr ER, Abbound CF, Ebersold MJ, Kao PC. Pituitary adenomas associated with hyperprolactinemia: a clinical and immunohistochemical study of 97 patients operated on transsphenoidally. Mayo Clin Proc. 1985;60(11):753–62.PubMedCrossRefGoogle Scholar
  18. 18.
    Bergsneider M, Mirsadraei L, Yong WH, Salamon N, Linetsky M, Wang MB, McArthur DL, Heaney AP. The pituitary stalk effect: is it a passing phenomenon? J Neuro-Oncol. 2014;117(3):477–84. doi: 10.1007/s11060-014-1386-5.CrossRefGoogle Scholar
  19. 19.
    Colao A, Di Sarno A, Guerra E, Pivonello R, Cappabianca P, Caranci F, Elefante A, Cavallo LM, Briganti F, Cirillo S, Lombardi G. Predictors of remission of hyperprolactinaemia after long-term withdrawal of cabergoline therapy. Clin Endocrinol. 2007;67(3):426–33. doi: 10.1111/j.1365-2265.2007.02905.x.CrossRefGoogle Scholar
  20. 20.
    Dekkers OM, Lagro J, Burman P, Jorgensen JO, Romijn JA, Pereira AM. Recurrence of hyperprolactinemia after withdrawal of dopamine agonists: systematic review and meta-analysis. J Clin Endocrinol Metab. 2010;95(1):43–51. doi: 10.1210/jc.2009-1238.PubMedCrossRefGoogle Scholar
  21. 21.
    Seppala M, Ranta T, Hirvonen E. Hyperprolactinaemia and luteal insufficiency. Lancet. 1976;1(7953):229–30.PubMedCrossRefGoogle Scholar
  22. 22.
    Molitch ME. Prolactinoma in pregnancy. Best Pract Res Clin Endocrinol Metab. 2011;25(6):885–96. doi: 10.1016/j.beem.2011.05.011.PubMedCrossRefGoogle Scholar
  23. 23.
    Sandyk R, Bergsneider M, Iacono RP. Acute psychosis in a woman with a prolactinoma. Int J Neurosci. 1987;37(3–4):187–90.PubMedCrossRefGoogle Scholar
  24. 24.
    Chang SC, Chen CH, Lu ML. Cabergoline-induced psychotic exacerbation in schizophrenic patients. Gen Hosp Psychiatry. 2008;30(4):378–80. doi: 10.1016/j.genhosppsych.2007.11.002.PubMedCrossRefGoogle Scholar
  25. 25.
    Tamasauskas A, Sinkunas K, Bunevicius A, Radziunas A, Skiriute D, Deltuva VP. Transsphenoidal surgery for microprolactinomas in women: results and prognosis. Acta Neurochir. 2012;154(10):1889–93. doi: 10.1007/s00701-012-1450-x.PubMedCrossRefGoogle Scholar
  26. 26.
    Martinkova J, Trejbalova L, Sasikova M, Benetin J, Valkovic P. Impulse control disorders associated with dopaminergic medication in patients with pituitary adenomas. Clin Neuropharmacol. 2011;34(5):179–81. doi: 10.1097/WNF.0b013e3182281b2f.PubMedCrossRefGoogle Scholar
  27. 27.
    Webster J. A comparative review of the tolerability profiles of dopamine agonists in the treatment of hyperprolactinaemia and inhibition of lactation. Drug Saf. 1996;14(4):228–38.PubMedCrossRefGoogle Scholar
  28. 28.
    Oh MC, Aghi MK. Dopamine agonist-resistant prolactinomas. J Neurosurg. 2011;114(5):1369–79. doi: 10.3171/2010.11.JNS101369.PubMedCrossRefGoogle Scholar
  29. 29.
    Vroonen L, Jaffrain-Rea ML, Petrossians P, Tamagno G, Chanson P, Vilar L, Borson-Chazot F, Naves LA, Brue T, Gatta B, Delemer B, Ciccarelli E, Beck-Peccoz P, Caron P, Daly AF, Beckers A. Prolactinomas resistant to standard doses of cabergoline: a multicenter study of 92 patients. Eur J Endocrinol. 2012;167(5):651–62. doi: 10.1530/EJE-12-0236.PubMedCrossRefGoogle Scholar
  30. 30.
    Carija R, Vucina D. Frequency of pituitary tumor apoplexy during treatment of prolactinomas with dopamine agonists: a systematic review. CNS Neurol Disord Drug Targets. 2012;11(8):1012–4.PubMedCrossRefGoogle Scholar
  31. 31.
    Kreutzer J, Buslei R, Wallaschofski H, Hofmann B, Nimsky C, Fahlbusch R, Buchfelder M. Operative treatment of prolactinomas: indications and results in a current consecutive series of 212 patients. Eur J Endocrinol. 2008;158(1):11–8. doi: 10.1530/EJE-07-0248.PubMedCrossRefGoogle Scholar
  32. 32.
    Losa M, Mortini P, Barzaghi R, Gioia L, Giovanelli M. Surgical treatment of prolactin-secreting pituitary adenomas: early results and long-term outcome. J Clin Endocrinol Metab. 2002;87(7):3180–6. doi: 10.1210/jcem.87.7.8645.PubMedCrossRefGoogle Scholar
  33. 33.
    Raverot G, Wierinckx A, Dantony E, Auger C, Chapas G, Villeneuve L, Brue T, Figarella-Branger D, Roy P, Jouanneau E, Jan M, Lachuer J, Trouillas J, Hypopronos. 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. 2010;95(4):1708–16. doi: 10.1210/jc.2009-1191.PubMedCrossRefGoogle Scholar
  34. 34.
    Qu X, Wang M, Wang G, Han T, Mou C, Han L, Jiang M, Qu Y, Zhang M, Pang Q, Xu G. Surgical outcomes and prognostic factors of transsphenoidal surgery for prolactinoma in men: a single-center experience with 87 consecutive cases. Eur J Endocrinol. 2011;164(4):499–504. doi: 10.1530/EJE-10-0961.PubMedCrossRefGoogle Scholar
  35. 35.
    Kristof RA, Schramm J, Redel L, Neuloh G, Wichers M, Klingmuller D. Endocrinological outcome following first time transsphenoidal surgery for GH-, ACTH-, and prolactinx-secreting pituitary adenomas. Acta Neurochir. 2002;144(6):555–61; discussion 561. doi: 10.1007/s00701-002-0938-1.
  36. 36.
    Gillam MP, Molitch ME. Prolactinoma. 3rd ed. London: Pituitary; 2011. p. 475–531. doi: 10.1016/B978-0-12-380926-1.10015-X.Google Scholar
  37. 37.
    Salvatori R. Surgical treatment of microprolactinomas: pros. Endocrine. 2014;47(3):725–9. doi: 10.1007/s12020-014-0281-3.PubMedCrossRefGoogle Scholar
  38. 38.
    Zaidi HA, Awad AW, Bohl MA, Chapple K, Knecht L, Jahnke H, White WL, Little AS. Comparison of outcomes between a less experienced surgeon using a fully endoscopic technique and a very experienced surgeon using a microscopic transsphenoidal technique for pituitary adenoma. J Neurosurg. 2015:1–9. doi: 10.3171/2015.4.JNS15102.
  39. 39.
    Micko AS, Wohrer A, Wolfsberger S, Knosp E. Invasion of the cavernous sinus space in pituitary adenomas: endoscopic verification and its correlation with an MRI-based classification. J Neurosurg. 2015;122(4):803–11. doi: 10.3171/2014.12.JNS141083.PubMedCrossRefGoogle Scholar
  40. 40.
    Cottier JP, Destrieux C, Brunereau L, Bertrand P, Moreau L, Jan M, Herbreteau D. Cavernous sinus invasion by pituitary adenoma: MR imaging. Radiology. 2000;215(2):463–9. doi: 10.1148/radiology.215.2.r00ap18463.PubMedCrossRefGoogle Scholar
  41. 41.
    Landolt AM, Keller PJ, Froesch ER, Mueller J. Bromocriptine: does it jeopardise the result of later surgery for prolactinomas? Lancet. 1982;2(8299):657–8.PubMedCrossRefGoogle Scholar
  42. 42.
    Bevan JS, Adams CB, Burke CW, Morton KE, Molyneux AJ, Moore RA, Esiri MM. Factors in the outcome of transsphenoidal surgery for prolactinoma and non-functioning pituitary tumour, including pre-operative bromocriptine therapy. Clin Endocrinol. 1987;26(5):541–56.CrossRefGoogle Scholar
  43. 43.
    Soule SG, Farhi J, Conway GS, Jacobs HS, Powell M. The outcome of hypophysectomy for prolactinomas in the era of dopamine agonist therapy. Clin Endocrinol. 1996;44(6):711–6.CrossRefGoogle Scholar
  44. 44.
    Webster J, Page MD, Bevan JS, Richards SH, Douglas-Jones AG, Scanlon MF. Low recurrence rate after partial hypophysectomy for prolactinoma: the predictive value of dynamic prolactin function tests. Clin Endocrinol. 1992;36(1):35–44.CrossRefGoogle Scholar
  45. 45.
    Shrivastava RK, Arginteanu MS, King WA, Post KD. Giant prolactinomas: clinical management and long-term follow up. J Neurosurg. 2002;97(2):299–306. doi: 10.3171/jns.2002.97.2.0299.PubMedCrossRefGoogle Scholar
  46. 46.
    Primeau V, Raftopoulos C, Maiter D. Outcomes of transsphenoidal surgery in prolactinomas: improvement of hormonal control in dopamine agonist-resistant patients. Eur J Endocrinol. 2012;166(5):779–86. doi: 10.1530/EJE-11-1000.PubMedCrossRefGoogle Scholar
  47. 47.
    Faglia G, Moriondo P, Travaglini P, Giovanelli MA. Influence of previous bromocriptine therapy on surgery for microprolactinoma. Lancet. 1983;1(8316):133–4.PubMedCrossRefGoogle Scholar
  48. 48.
    Fahlbusch R, Buchfelder M. Present status of neurosurgery in the treatment of prolactinomas. Neurosurg Rev. 1985;8(3–4):195–205.PubMedCrossRefGoogle Scholar
  49. 49.
    Hubbard JL, Scheithauer BW, Abboud CF, Laws Jr ER. Prolactin-secreting adenomas: the preoperative response to bromocriptine treatment and surgical outcome. J Neurosurg. 1987;67(6):816–21. doi: 10.3171/jns.1987.67.6.0816.PubMedCrossRefGoogle Scholar
  50. 50.
    Menucci M, Quiñones-Hinojosa A, Burger P, Salvatori R. Effect of dopaminergic drug treatment on surgical findings in prolactinomas. Pituitary. 2011;14(1):68–74. doi:10.1007/s11102–010–0261-4.Google Scholar
  51. 51.
    Oldfield EH, Vortmeyer AO. Development of a histological pseudocapsule and its use as a surgical capsule in the excision of pituitary tumors. J Neurosurg. 2006;104(1):7–19. doi: 10.3171/jns.2006.104.1.7.PubMedCrossRefGoogle Scholar
  52. 52.
    Babey M, Sahli R, Vajtai I, Andres RH, Seiler RW. Pituitary surgery for small prolactinomas as an alternative to treatment with dopamine agonists. Pituitary. 2011;14(3):222–30. doi: 10.1007/s11102-010-0283-y.PubMedCrossRefGoogle Scholar
  53. 53.
    Amar AP, Couldwell WT, Chen JC, Weiss MH. Predictive value of serum prolactin levels measured immediately after transsphenoidal surgery. J Neurosurg. 2002;97(2):307–14. doi: 10.3171/jns.2002.97.2.0307.PubMedCrossRefGoogle Scholar
  54. 54.
    Feigenbaum SL, Downey DE, Wilson CB, Jaffe RB. Transsphenoidal pituitary resection for preoperative diagnosis of prolactin-secreting pituitary adenoma in women: long term follow-up. J Clin Endocrinol Metab. 1996;81(5):1711–9. doi: 10.1210/jcem.81.5.8626821.PubMedGoogle Scholar
  55. 55.
    Couldwell WT, Weiss MH. Defining postoperative values for successful resection of prolactinomas. J Neurosurg. 1996;85(5):990–1.PubMedGoogle Scholar
  56. 56.
    Guieu R, Dufour H, Grisoli F, Jaquet P, Guieu Y, Rosso JP, Munier M, Dicostanzo V, Brue T, Enjalbert A, Begoud D, Rochat H. An ultrarapid prognostic index in microprolactinoma surgery. J Neurosurg. 1999;90(6):1037–41. doi: 10.3171/jns.1999.90.6.1037.PubMedCrossRefGoogle Scholar
  57. 57.
    Ammirati M, Wei L, Ciric I. Short-term outcome of endoscopic versus microscopic pituitary adenoma surgery: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry. 2013;84(8):843–9. doi: 10.1136/jnnp-2012-303194.PubMedCrossRefGoogle Scholar
  58. 58.
    Sughrue ME, Chang EF, Tyrell JB, Kunwar S, Wilson CB, Blevins Jr LS. Pre-operative dopamine agonist therapy improves post-operative tumor control following prolactinoma resection. Pituitary. 2009;12(3):158–64. doi: 10.1007/s11102-008-0135-1.PubMedCrossRefGoogle Scholar
  59. 59.
    Sinha S, Sharma BS, Mahapatra AK. Microsurgical management of prolactinomas - clinical and hormonal outcome in a series of 172 cases. Neurol India. 2011;59(4):532–6. doi: 10.4103/0028-3886.84332.PubMedCrossRefGoogle Scholar
  60. 60.
    Balaker AE, Bergsneider M, Martin NA, Wang MB. Evolution of sinonasal symptoms following endoscopic anterior skull base surgery. Skull Base. 2010;20(4):245–51. doi: 10.1055/s-0030-1249248.PubMedPubMedCentralCrossRefGoogle Scholar
  61. 61.
    McCoul ED, Anand VK, Bedrosian JC, Schwartz TH. Endoscopic skull base surgery and its impact on sinonasal-related quality of life. Int Forum Allergy Rhinol. 2012;2(2):174–81. doi: 10.1002/alr.21008.PubMedCrossRefGoogle Scholar
  62. 62.
    de Almeida JR, Snyderman CH, Gardner PA, Carrau RL, Vescan AD. Nasal morbidity following endoscopic skull base surgery: a prospective cohort study. Head Neck. 2011;33(4):547–51. doi: 10.1002/hed.21483.PubMedCrossRefGoogle Scholar
  63. 63.
    Thompson CF, Suh JD, Liu Y, Bergsneider M, Wang MB. Modifications to the endoscopic approach for anterior skull base lesions improve postoperative sinonasal symptoms. J Neurol Surg B Skull Base. 2014;75(1):65–72. doi: 10.1055/s-0033-1356492.PubMedGoogle Scholar
  64. 64.
    Esposito V, Santoro A, Minniti G, Salvati M, Innocenzi G, Lanzetta G, Cantore G. Transsphenoidal adenomectomy for GH-, prolactin- and ACTH-secreting pituitary tumours: outcome analysis in a series of 125 patients. Neurol Sci. 2004;25(5):251–6. doi: 10.1007/s10072-004-0351-z.
  65. 65.
    Jane Jr JA, Laws Jr ER. The surgical management of pituitary adenomas in a series of 3,093 patients. J Am Coll Surg. 2001;193(6):651–9.PubMedCrossRefGoogle Scholar
  66. 66.
    Liu JK, Couldwell WT. Contemporary management of prolactinomas. Neurosurg Focus. 2004;16(4):E2.PubMedCrossRefGoogle Scholar
  67. 67.
    Couldwell WT, Weiss MH. Medical and surgical management of microprolactinoma. Pituitary. 2004;7(1):31–2.PubMedCrossRefGoogle Scholar
  68. 68.
    Cesar de Oliveira Naliato E, Dutra Violante AH, Caldas D, Lamounier Filho A, Rezende Loureiro C, Fontes R, Schrank Y, Gomes de Souza R, Vaisman M, Guerra E, Sebastian A, Colao A. Quality of life in women with microprolactinoma treated with dopamine agonists. Pituitary. 2008;11(3):247–54. doi: 10.1007/s11102-008-0091-9.PubMedCrossRefGoogle Scholar
  69. 69.
    Raappana A, Pirila T, Ebeling T, Salmela P, Sintonen H, Koivukangas J. Long-term health-related quality of life of surgically treated pituitary adenoma patients: a descriptive study. ISRN Endocrinol. 2012;2012:675310. doi: 10.5402/2012/675310.PubMedPubMedCentralGoogle Scholar
  70. 70.
    Ritvonen E, Karppinen A, Sintonen H, Vehkavaara S, Kivipelto L, Roine RP, Niemela M, Schalin-Jantti C. Normal long-term health-related quality of life can be achieved in patients with functional pituitary adenomas having surgery as primary treatment. Clin Endocrinol. 2015;82(3):412–21. doi: 10.1111/cen.12550.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • Won Kim
    • 1
    Email author
  • Srinivas Chivukula
    • 1
  • Anthony Heaney
    • 2
  • Marilene Wang
    • 3
  • Marvin Bergsneider
    • 1
  1. 1.Department of NeurosurgeryDavid Geffen School of Medicine at UCLALos AngelesUSA
  2. 2.Department of MedicineDavid Geffen School of Medicine at UCLALos AngelesUSA
  3. 3.Department of Head and Neck SurgeryDavid Geffen School of Medicine at UCLALos AngelesUSA

Personalised recommendations