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

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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.

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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.

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    Authors and Affiliations

    1. Departments of Neurosurgery, Bern University Hospital, University of Bern, Bern, Switzerland

      Lukas Andereggen, Robert H. Andres, Jürgen Beck & Rolf W. Seiler

    2. Endocrinology Diabetes and Metabolism, Bern University Hospital, University of Bern, Bern, Switzerland

      Janine Frey & Emanuel Christ

    3. Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland

      Marwan El-Koussy

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    1. Lukas Andereggen
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    Correspondence to Emanuel Christ.

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    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.

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    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.

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    Lukas Andereggen and Janine Frey contributed equally to this work.

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    Andereggen, L., Frey, J., Andres, R.H. et al. 10-year follow-up study comparing primary medical vs. surgical therapy in women with prolactinomas. Endocrine 55, 223–230 (2017). https://doi.org/10.1007/s12020-016-1115-2

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