The Changing Treatment Paradigm for Prolactinoma—A Prospective Series of 100 Consecutive Neurosurgical Cases
Authors: van Trigt Victoria R , Bakker Leontine E H , Pelsma Iris C M , Zandbergen Ingrid M , Jentus Maaia M , Kruit Mark C , Dekkers Olaf M , van Furth Wouter R , Verstegen Marco J T , Biermasz Nienke R ,   Dutch Prolactinoma Study Group, van den Akker-van Marle M E , van Andel M , Andela C D , van den Berge C K A , Berk-Planken I I L , Bisschop P H L T , Bizino M B , van Bon A C , Boogaarts J , Boot C L , Bootsma A H , Burhani B , le Cessie S , Drent M L , Feelders R A , Fredriks E , Goddrie M , de Graaf J P , Haak H R , Hoogmoed J , van den Hout W B , Johannsson-Vidarsdóttir S , Kapiteijn K K , van der Klauw M M , Kramer M , Kuijlen J M A , Massolt E T , Morreau J , Pereira Arias A M , Peul W C , Leijtens E L , Lobatto D J , Pereira Arias-Bouda L M , Ramautar S R , Rikken N E T , Ritman A , Schroijen M A , Simsek S , Sleddering M A , Smolders E , Stades A M E , van der Steen A , Stegenga M E , Stenvers D J , Swinnen S , van Thiel S W , Traas M A F , van de Ven A C , Vergeer R A , Vermeulen M , Vriesendorp T M , Wentholt I M E , de Wit H M , Wakelkamp I M M J , Zagers D , Zamanipoor Najafabadi A H , Zuurmond M S 
Published: September 2024

Abstract

Purpose
To evaluate patients with prolactinoma treated surgically in a time when elective prolactinoma surgery became routine in our center, using a comprehensive outcome set, focusing on preoperative assessments, surgical outcomes, and health-related quality of life (HR-QoL).

Methods
Cohort of consecutive patients with prolactinoma undergoing surgery between January 2021 and August 2023. Clinical data were collected during multidisciplinary team meetings/from medical records at distinct timepoints: (1) presurgery, (2) 2 weeks postsurgery, (3) 6 months postsurgery, and (4) follow-up (median, 15.0 [10.0-24.8 months]). HR-QoL was measured using the Leiden Bothers and Needs Pituitary questionnaire. Data were described for all patients, and patients undergoing elective total resection, with additional subgroups of (1) patients undergoing a high-probability first total resection and (2) reoperations aiming for total resection.

Results
One hundred surgically treated patients with prolactinoma were included (72 female). Dopamine agonist intolerance was the most frequent indication (n = 68). The surgical goal (debulking/total resection) was achieved in 90% of patients. Long-term complications occurred in 4% of patients. Seventy-eight patients underwent an elective total resection, achieving remission in 91%. The subsets of preoperatively estimated high-probability-first total resections (n = 52) and reoperations (n = 9) achieved remission in 92% and 89%, respectively. Leiden Bothers and Needs Pituitary Total Bothers and Total Needs scores improved significantly after surgery (P &lt; .001, Δ-3.4 [interquartile range, −14.4 to −0.9] and P = .006, Δ-1.8 [interquartile range, −11.9 to 1.3]), respectively.

Conclusion
High remission rates were achieved, improving HR-QoL, demonstrating (repeat) prolactinoma surgery is effective in an experienced pituitary center, as highlighted in the most recent guideline (2023).