Abstract
Surgery for prolactinoma patients is usually reserved for those who are intolerant of or have an inadequate response to medication. We report the results of surgical treatment in these patients. Methods: We retrospectively analyzed a consecutive series of patients with histopathologically confirmed prolactinomas; two patients treated with craniotomy and 77 patients with prolactinomas treated by transsphenoidal surgery between 1993 and 2003. We evaluated symptomatic patients who did not tolerate or did not respond to dopamine agonist therapy (persistent hyperprolactinemia and/or no shrinkage of tumor mass). We report remission rates, prolactin levels, and medications either not tolerated or ineffective. Results: Eighteen patients were intolerant of medical therapy (nine with macroadenomas and nine with microadenomas). Postoperatively, 12 patients (67%) achieved normalization of prolactin and relief of symptoms from surgery alone. Sixty-one patients were resistant to dopamine agonist therapy (45 with macroadenomas and 16 with microadenomas). Forty-six patients had both elevated prolactin levels and no shrinkage. 22 patients (36%) achieved normal postoperative prolactin levels. Ten of the remaining 39 patients required adjunctive medical therapy to maintain normal prolactin levels and relief of symptoms. Conclusions: Remission through surgery was achieved in 67% (12 of 18 patients, 4 macroadenomas and 8 microadenomas) of prolactinoma patients who fail medical therapy with dopamine agonists because of intolerance to medication. Remission was also achieved in 36% (22 of 61 patients, 12macroadenomas and 10 microadenomas) of patients who demonstrated resistance to dopamine agonist medication.
Similar content being viewed by others
References
Vance ML, Thorner MO. Prolactin: hyperprolactinemic syndromes and management. In: DeGroot LJ (ed.), Textbook of Endocrinology, 2nd edition, Philadelphia, London, Toronto, Mexicao City, Rio. de Janerio, Sydney, Tokyo, Hong Kong: WB Saunders Company, 1989, pp. 408–418.
Colao A, Lombardi G. Growth-hormone and prolactin excess. Lancet 1998;352:1455–1461.
Colao A, Annunziato L, Lombardi G. Treatment of prolactinomas. Ann Med 1998;30:452–459.
Vance ML. New directions in the treatment of hyperprolactinemia. The Endocrinologist 1997;7:153–159.
Biller BM, Molitch ME, Vance ML, Cannistraro KB, Davis KR, Simons JA, Schoenfelder JR, Klibanski A. Treatment of prolactin- secreting macroadenomas with the once-weekly dopamine agonist cabergoline. J Clin Endocrinol Metab 1996;81:2338–2343.
Colao A, Di Sarno A, Sarnacchiaro F, Ferone D, Di Renzo G, Merola B, Annunziato L, Lombardi G. Prolactinomas resistant to standard dopamine agonists respond to chronic cabergoline treatment. J Clin Endocrinol Metab 1997;82:876–883.
Vance ML. European experience with cabergoline in the treatment of hyperprolactinemia. The Endocrinologist 1997;7:409–413.
Vance ML. When Bromocriptine Fails. The Endocrinologist 1991;1:119–124.
Webster J, Piscitelli G, Polli A, Ferrari CI, Ismail I, Scanlon MF. A comparison of cabergoline and bromocriptine in the treatment of hyperprolactinemic amenorrhea. N Engl J Med 1994;331:904–909.
Delgrange E, Crabbe J, Donckier J. Late development of resistance to bromocriptine in a patient with macroprolactinoma. Horm Res 1998;49:250–253.
Delgrange E, Maiter D, Donckier J. Effects of the dopamine agaonist cabergoline in patients with prolactinoma intolerant or resistant to bromocriptine. Eur J Endocrinol 1998;134:454–456.
Brue T, Pellegrini I, Gunz G, Morange I, Dewailly D, Brownell J, Enjalbert A, Jaquet P. Effects of the dopamine agonist CV 205–502 in human prolactinomas resistant to bromocriptine. J Clin Endocrinol Metab 1992;74:577–584.
Brue T, Pellegrini I, Priou A, Morange I, Jaquet P. Prolactinomas and resistance to dopamine-agonists. Horm Res 1992;38:84–89.
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;87:3180–3186.
Massoud F, Serri O, Hardy J, Somma M, Beauregard H. Transsphenoidal adenectomy for microprolactinomas: 10 to 20 yrs of follow-up. Surgical Neurol 1996;45:341–346.
Tyrrell JB, Lamborn KR, Hannegan LT, Applebury CB, Wilson CB. Transsphenoidal microsurgical therapy of prolactinomas: initial outcomes and long term results. Neurosurgery 1999;44:254–261.
Molitch ME, Thorner MO, Wilson C. Therapeutic controversy:management of prolactinomas. J Clin Endocrinol Metab 1997;82:996–1000.
Kovacs K, Stefaneanu L, Hovarth E. Prolactin-producing pituitary tumor: resistance to dopamine agonist therapy. J Neurosurg 1995;82:886–890.
Di Sarno A, Landi ML, Cappabianca P, Di Salle F, Rossi FW, Pivonello R, Di Somma C, Faggiano A, Lombardi G, Colao A. Resistance to cabergoline as compared with bromocriptine in hyperprolactinemia: Prevalence, clinical definition, and therapeutic strategy. J Clin Endocrinol Metab 2001;86:5256–61.
Webster J, Piscitelli G, Polli A, D'Alberton A, Falsetti L, Ferrari C, Fioretti P, Giordano G, L'Hermite M, Ciccarelli E. The efficacy and tolerability of long-term cabergoline therapy in hyperprolactinemic disorders: an open, uncontrolled, multicentre study. Clin Endocrinol 1993;39:323–329.
Landolt AM. Prolactinomas: preoperative bromocriptine treatment, surgical results. In: Barrow DL (ed.): Perspectives in Neurological Surgery. St. Louis: Quality Medical Publishing, 1990:105–115.
Faglia G, Moriondo P, Travaglini P, Giovanelli MA. Influence of previous bromocriptine therapy on surgery for microprolactinoma. Lancet 1983;1:133–134.
Weiss MH, Teal J, Gott P, Wycoff R, Yadley R, Apuzzo ML, Giannotta SL, Kletzky O, March C. Natural history of microprolactinomas: six-year follow-up. Neurosurgery 1983;12:180–183.
Perrin G, Treluyer C, Trouillas J, Sassolas G, Goutelle A. Surgical outcome and pathological effects of bromocriptine preoperative treatment in prolactinomas. Pathol Res Pract 1991;187:587–592.
Hubbard JL, Scheithauer BW, Laws ER Jr. Prolactin secreting adenomas: the preoperative response to bromocriptine treatment and surgical outcome. J Neurosurg 1987;67:816–821.
Meij BP, Lopes MB, Ellegala DB, Alden TD, Laws ER Jr. The long term significance of microscopic dural invasion 354 patients with pituitary adenomas treated with transsphenoidal surgery. J Neurosurg 2002;96:195–208.
Thomson JA, Davies DL, McLaren EH, Teasdale GM. Ten year follow up of microprolactinoma treated by transsphenoidal surgery. BMJ 1994;309:409–1410.
Faria M, Tindall G. Transsphenoidal microsurgery for prolactin-secreting pituitary adenomas. J Neurosurg 1982; 56:33–43.
Hardy J, Beauregard H, Robert F. Prolactin-secreting pituitary adenomas: transsphenoidal microsurgical treatment. Clin Neurosurg1980;27:38–47.
Turner HE, Adams CBT, Wass AH. Transsphenoidal surgery for microprolactinoma: an acceptable alternative to dopamine agonists? Eur J Endocrinology 1999;140:43–47.
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. Clinical Endocrinol (Oxf) 1992;36:35–44.
Nomikos P, Buchfelder M, Fahlbusch R. Current management of prolactinomas. J Neurooncol 2001;54:139–150.
Delgrange E, Trouillas J, Maiter D, Donckier J, Tourniaire J. Sex-related difference in the growth of prolactinomas: a clinical and proliferation marker study. J Clin Endocrinol Metab 1997;82:2102–7.
Hulting AL, Muhr C, Lundberg PO, Werner S. Prolactinomas in men: clinical characteristics and the effect of bromocriptine treatment. Acta Med Scand 1985;217:101–109.
Calle-Rodrigue RD, Giannini C, Scheithauer BW, Lloyd RV, Wollan PC, Kovacs KT, Stefaneanu L, Ebright AB, Abboud CF, Davis DH. Prolactinomas in male and female patients: A comparative clinicopathologic study. Mayo Clin Proc 1998;73:1046–1052.
Jane JA Jr, Laws ER Jr. The surgical management of pituitary adenomas in a series of 3,093 patients. J Am Coll Surg 2001;193:651–659.
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;44:711–716.
Ozgen T, Oruckaptan HH, Ozcan OE, Acikgoz B. Prolactin secreting pituitary adenomas:analysis of 429 surgically treated patients, effect of adjuvant treatment modalities and review of the literature. Acta Neurochir (Wien) 1999;141:1287–1294.
Tran LM, Blount L, Horton D, Sadeghi A, Parker RG. Radiation therapy of pituitary tumors: results in 95 cases. Am J Clin Oncol 1991;14:25–29.
Ginsburg J, Hardman P, Thomas M. Vaginal bromocriptine. Lancet 1991;338(8776):1205–1206.
Jasonni VM, Raffelli R, de March A, Frank G, Flamigni C. Vaginal bromocriptine in hyperprolactinemic patients and puerperal women. Acta Obstet Gynecol Scand 1991;70(6):493–495.
Kletzky OA, Vermesh M. Effectiveness of vaginal bromocriptine in treating women with hyperprolactinemia. Fertil Steril 1989;51(2):269–272.
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 (Oxf) 1987;26(5):541–56.
Motta T, de Vincentiis S, Marchini M, Colombo N, D'Alberton A. Vaginal cabergoline in the treatment of hyperprolactinemic patients intolerant to oral dopaminergics. Fertil Steril 1996;65(2):440–442.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hamilton, D.K., Vance, M.L., Boulos, P.T. et al. Surgical Outcomes in Hyporesponsive Prolactinomas: Analysis of patients with Resistance or Intolerance to Dopamine Agonists. Pituitary 8, 53–60 (2005). https://doi.org/10.1007/s11102-005-5086-1
Issue Date:
DOI: https://doi.org/10.1007/s11102-005-5086-1