Prolactinomas: Prognostic Factors of Early Remission After Transsphenoidal Surgery

Prolactinomas: Prognostic Factors of Early Remission After Transsphenoidal Surgery

Most patients with prolactinomas receive pharmacological treatment only, resulting in limited research on the predictors of successful prolactinoma surgery. In this study, we analyzed whether early postoperative serum prolactin concentrations and selected tumor characteristics could predict early, h...

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Published in:Frontiers in endocrinology (Lausanne) Vol. 11; p. 439
Main Authors: Zielinski, Grzegorz, Ozdarski, Marcin, Maksymowicz, Maria, Szamotulska, Katarzyna, Witek, Przemysław
Format: Journal Article
Language:English
Published: Switzerland Frontiers Media S.A 07-07-2020
Subjects:
Adult
Biomarkers - blood
dopamine agonist
Endocrinology
Endoscopy
Female
Follow-Up Studies
Humans
Male
pituitary adenoma
Pituitary Neoplasms - blood
Pituitary Neoplasms - pathology
Pituitary Neoplasms - surgery
plurihormonality
PRL
Prognosis
Prolactin - blood
prolactinoma
Prolactinoma - blood
Prolactinoma - pathology
Prolactinoma - surgery
Prospective Studies
Remission Induction
Sphenoid Bone - surgery
transsphenoidal surgery
transsphenoidal surgery
pituitary adenoma
plurihormonality
PRL
dopamine agonist
prolactinoma
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Summary:Most patients with prolactinomas receive pharmacological treatment only, resulting in limited research on the predictors of successful prolactinoma surgery. In this study, we analyzed whether early postoperative serum prolactin concentrations and selected tumor characteristics could predict early, hormonal remission after removal of prolactinomas. We prospectively enrolled 48 consecutive patients with prolactinomas who underwent transsphenoidal resection performed by the same surgeon. Early remission, defined as a lack of hyperprolactinemia symptoms and normalization of serum prolactin concentration, was ascertained in all patients at 3 months. We evaluated the invasiveness of prolactinomas on the Knosp grading scale and measured serum prolactin concentrations on the first postoperative day. Routine immunohistochemical analysis, evaluation for plurihormonality, and assessment of the Ki-67 proliferation index (<3 or ≥3% of positive nuclei) were performed in all tumor samples. Of 48 patients, 38 (79%) achieved early biochemical remission at 3 months. Patients in early remission at 3 months had lower serum prolactin concentrations on the first postoperative day than patients with recurrent or persistent hyperprolactinemia ( < 0.001). Using univariate logistic regression, larger maximum tumor diameter ( = 0.014), higher Knosp grade ( < 0.001), and plurihormonality predicted remission at 3 months ( = 0.021). However, using multivariate stepwise logistic regression, only the Knosp grade remained significant ( < 0.001). Radiological assessment of prolactinoma invasiveness (Knosp grades) and early postoperative serum prolactin concentrations are important predictors of early remission following transsphenoidal prolactinoma resection.
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Edited by: Marek Bolanowski, Wroclaw Medical University, Poland
This article was submitted to Pituitary Endocrinology, a section of the journal Frontiers in Endocrinology
These authors have contributed equally to this work
Reviewed by: Lucio Vilar, Federal University of Pernambuco, Brazil; Ilan Shimon, Rabin Medical Center, Israel
ISSN:1664-2392
1664-2392
DOI:10.3389/fendo.2020.00439