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

Andereggen, Lukas; Frey, Janine; Andres, Robert; El-Koussy, Marwan; Beck, Jürgen; Seiler, Rolf; Christ, Emanuel (2017). 10-year follow-up study comparing primary medical vs. surgical therapy in women with prolactinomas. Endocrine, 55(1), pp. 223-230. Springer 10.1007/s12020-016-1115-2

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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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Gynaecology
04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Endocrinology, Diabetology and Clinical Nutrition
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology

UniBE Contributor:

Andereggen, Lukas; Frey, Janine; Andres, Robert; El-Koussy, Marwan; Beck, Jürgen; Seiler, Rolf and Christ, Emanuel

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1355-008X

Publisher:

Springer

Language:

English

Submitter:

Martin Zbinden

Date Deposited:

27 Oct 2016 14:08

Last Modified:

15 Sep 2017 14:51

Publisher DOI:

10.1007/s12020-016-1115-2

PubMed ID:

27688009

Uncontrolled Keywords:

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

BORIS DOI:

10.7892/boris.89337

URI:

https://boris.unibe.ch/id/eprint/89337

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