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Long-term Outcome of Microscopic Transsphenoidal Surgery for Prolactinomas as an Alternative to Dopamine Agonists

BACKGROUND: Although long-term dopamine agonist (DA) therapy is recommended as a first-line treatment for prolactinoma, some patients may prefer surgical treatment because of the potential adverse effects of long-term medication, or the desire to become pregnant. This study aimed to determine whethe...

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Autores principales: Park, Kawngwoo, Park, Kwang Hyon, Park, Hye Ran, Lee, Jae Meen, Kim, Yong Hwy, Kim, Dong-Young, Won, Tae-Bin, Kong, Sung Hye, Kim, Jung Hee, Shin, Chan Soo, Paek, Sun Ha
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Korean Academy of Medical Sciences 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8055511/
https://www.ncbi.nlm.nih.gov/pubmed/33876586
http://dx.doi.org/10.3346/jkms.2021.36.e97
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author Park, Kawngwoo
Park, Kwang Hyon
Park, Hye Ran
Lee, Jae Meen
Kim, Yong Hwy
Kim, Dong-Young
Won, Tae-Bin
Kong, Sung Hye
Kim, Jung Hee
Shin, Chan Soo
Paek, Sun Ha
author_facet Park, Kawngwoo
Park, Kwang Hyon
Park, Hye Ran
Lee, Jae Meen
Kim, Yong Hwy
Kim, Dong-Young
Won, Tae-Bin
Kong, Sung Hye
Kim, Jung Hee
Shin, Chan Soo
Paek, Sun Ha
author_sort Park, Kawngwoo
collection PubMed
description BACKGROUND: Although long-term dopamine agonist (DA) therapy is recommended as a first-line treatment for prolactinoma, some patients may prefer surgical treatment because of the potential adverse effects of long-term medication, or the desire to become pregnant. This study aimed to determine whether surgical treatment of prolactinomas could be an alternative to DA therapy. METHODS: In this retrospective study, 96 consecutive patients (74 female, 22 male) underwent primary pituitary surgery without long-term DA treatment for prolactinomas at a single institution from 1990 to 2010. All patients underwent primary surgical treatment in the microscopic transsphenoidal approach (TSA). RESULTS: The median age and median follow-up period were 31 (16–73) years and 139.1 (12.2–319.6) months, respectively. An initial overall remission was accomplished in 47.9% (46 of 96 patients, 33 macroadenomas, and 13 microadenomas) of patients. DA dose reduction was achieved in all patients after TSA. A better remission rate was independently predicted by lower diagnostic prolactin levels and by a greater extent of surgical resection. Overall remission at the last follow-up was 33.3%, and the overall recurrence rate was 30.4%. The permanent complication rate was 3.1%, and there was no mortality. CONCLUSION: TSA can be considered a safe and potentially curative treatment for selective microprolactinomas as an alternative to treatment with a long-term DA.
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spelling pubmed-80555112021-04-29 Long-term Outcome of Microscopic Transsphenoidal Surgery for Prolactinomas as an Alternative to Dopamine Agonists Park, Kawngwoo Park, Kwang Hyon Park, Hye Ran Lee, Jae Meen Kim, Yong Hwy Kim, Dong-Young Won, Tae-Bin Kong, Sung Hye Kim, Jung Hee Shin, Chan Soo Paek, Sun Ha J Korean Med Sci Original Article BACKGROUND: Although long-term dopamine agonist (DA) therapy is recommended as a first-line treatment for prolactinoma, some patients may prefer surgical treatment because of the potential adverse effects of long-term medication, or the desire to become pregnant. This study aimed to determine whether surgical treatment of prolactinomas could be an alternative to DA therapy. METHODS: In this retrospective study, 96 consecutive patients (74 female, 22 male) underwent primary pituitary surgery without long-term DA treatment for prolactinomas at a single institution from 1990 to 2010. All patients underwent primary surgical treatment in the microscopic transsphenoidal approach (TSA). RESULTS: The median age and median follow-up period were 31 (16–73) years and 139.1 (12.2–319.6) months, respectively. An initial overall remission was accomplished in 47.9% (46 of 96 patients, 33 macroadenomas, and 13 microadenomas) of patients. DA dose reduction was achieved in all patients after TSA. A better remission rate was independently predicted by lower diagnostic prolactin levels and by a greater extent of surgical resection. Overall remission at the last follow-up was 33.3%, and the overall recurrence rate was 30.4%. The permanent complication rate was 3.1%, and there was no mortality. CONCLUSION: TSA can be considered a safe and potentially curative treatment for selective microprolactinomas as an alternative to treatment with a long-term DA. The Korean Academy of Medical Sciences 2021-03-26 /pmc/articles/PMC8055511/ /pubmed/33876586 http://dx.doi.org/10.3346/jkms.2021.36.e97 Text en © 2021 The Korean Academy of Medical Sciences. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Park, Kawngwoo
Park, Kwang Hyon
Park, Hye Ran
Lee, Jae Meen
Kim, Yong Hwy
Kim, Dong-Young
Won, Tae-Bin
Kong, Sung Hye
Kim, Jung Hee
Shin, Chan Soo
Paek, Sun Ha
Long-term Outcome of Microscopic Transsphenoidal Surgery for Prolactinomas as an Alternative to Dopamine Agonists
title Long-term Outcome of Microscopic Transsphenoidal Surgery for Prolactinomas as an Alternative to Dopamine Agonists
title_full Long-term Outcome of Microscopic Transsphenoidal Surgery for Prolactinomas as an Alternative to Dopamine Agonists
title_fullStr Long-term Outcome of Microscopic Transsphenoidal Surgery for Prolactinomas as an Alternative to Dopamine Agonists
title_full_unstemmed Long-term Outcome of Microscopic Transsphenoidal Surgery for Prolactinomas as an Alternative to Dopamine Agonists
title_short Long-term Outcome of Microscopic Transsphenoidal Surgery for Prolactinomas as an Alternative to Dopamine Agonists
title_sort long-term outcome of microscopic transsphenoidal surgery for prolactinomas as an alternative to dopamine agonists
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8055511/
https://www.ncbi.nlm.nih.gov/pubmed/33876586
http://dx.doi.org/10.3346/jkms.2021.36.e97
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