This preprint is under consideration at Journal of Neuro-Oncology. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
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Research Article
Pier Paolo Mattogno
Policlinico A Gemelli: Policlinico Universitario Agostino Gemelli
Corresponding Author
ORCiD: https://orcid.org/0000-0003-2857-9096
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Backgrounds: Prolactinomas represent a unique challenge for endocrinologists and neurosurgeons. Considering recent innovations in surgical practice, the authors aimed to investigate the best management for prolactinomas.
Methods: A retrospective, cross-sectional and monocentric study was designed. Consecutive patients affected for prolactinomas were enrolled if treated with first line treatment with dopamine-agonist (DA) or trans-sphenoidal surgery (TS). Patients carried giant prolactinomas and those with a follow-up < 12 months were excluded.
Results: 259 patients were enrolled. The first treatment was DA for 140 patients and TS for 119 cases. 146 of 249 patients (58.6%) needed a second therapy. Mean follow up was 102.2 months (12-438 months). Surgery highly impacted on the cure rate, in particular in females (p=0.0021) and in microprolactinomas (p=0.0020). Considering multivariate analysis, female gender and surgical treatment in the course of clinical history were the only independent positive predictors of cure at the end of 5 years follow-up (p=0.0016, p=0.0005). The evaluation of serum prolactin (24 hours after TS) revealed that 86.4% of patients with post-operative PRL≤10 ng/ml resulted cured at the end of follow-up (p< 0.0001).
Conclusion: According to our experience, surgery allows a high cure rate of prolactinomas, particularly in females with microadenoma, with a good safety profile. TS for prolactinomas should be considered as concrete option, during the multidisciplinary evaluation, in centers of reference for pituitary diseases.
Keywords
Prolactinoma, transsphenoidal surgery, dopamine agonists, DA withdrawal, cure rate.
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This preprint is under consideration at Journal of Neuro-Oncology. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research Article
Pier Paolo Mattogno
Policlinico A Gemelli: Policlinico Universitario Agostino Gemelli
Corresponding Author
ORCiD: https://orcid.org/0000-0003-2857-9096
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 12 Mar, 2021
No community comments so far
Editor assigned
On 04 Mar, 2021
Reviewers invited
Invitations sent on 04 Mar, 2021
Review #? received
Received 04 Mar, 2021
First submitted
On 26 Feb, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Backgrounds: Prolactinomas represent a unique challenge for endocrinologists and neurosurgeons. Considering recent innovations in surgical practice, the authors aimed to investigate the best management for prolactinomas.
Methods: A retrospective, cross-sectional and monocentric study was designed. Consecutive patients affected for prolactinomas were enrolled if treated with first line treatment with dopamine-agonist (DA) or trans-sphenoidal surgery (TS). Patients carried giant prolactinomas and those with a follow-up < 12 months were excluded.
Results: 259 patients were enrolled. The first treatment was DA for 140 patients and TS for 119 cases. 146 of 249 patients (58.6%) needed a second therapy. Mean follow up was 102.2 months (12-438 months). Surgery highly impacted on the cure rate, in particular in females (p=0.0021) and in microprolactinomas (p=0.0020). Considering multivariate analysis, female gender and surgical treatment in the course of clinical history were the only independent positive predictors of cure at the end of 5 years follow-up (p=0.0016, p=0.0005). The evaluation of serum prolactin (24 hours after TS) revealed that 86.4% of patients with post-operative PRL≤10 ng/ml resulted cured at the end of follow-up (p< 0.0001).
Conclusion: According to our experience, surgery allows a high cure rate of prolactinomas, particularly in females with microadenoma, with a good safety profile. TS for prolactinomas should be considered as concrete option, during the multidisciplinary evaluation, in centers of reference for pituitary diseases.
Figure 1
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