Long-term endocrine outcomes of transsphenoidal surgery for prolactinomas: a 20-year single-center cohort study.

IF 3.8 2区医学 Q2 ENDOCRINOLOGY & METABOLISM

Pituitary Pub Date : 2026-08-20 DOI:10.1007/s11102-026-01749-8

Roméo Bujiriri Murhega, Stefan Matei Constantinescu, Christian Raftopoulos, Dominique Maiter, Edward Fomekong

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Abstract

Background: The role of transsphenoidal surgery in the management of prolactinomas remains debated in the era of dopamine agonist therapy. This descriptive study evaluated the long-term endocrine outcomes of transsphenoidal surgery in a highly selected single-center surgical cohort.

Methods: We retrospectively reviewed all patients who underwent transsphenoidal surgery for prolactinomas at a tertiary referral center between September 1995 and July 2015. Biochemical remission was defined as normalization of serum prolactin levels 6 months after surgery. Persistent disease and recurrence were assessed during long-term follow-up. The analysis was descriptive and all subgroup comparisons were exploratory.

Results: Fifty-five patients were included (47 women and 8 men; median age, 30 years), comprising 35 microprolactinomas (64%), 18 macroprolactinomas (33%), and 2 giant prolactinomas (3%). The median follow-up was 10.8 years. Biochemical remission at 6 months was achieved in 29 patients (53%), whereas persistent disease and recurrence were observed in 21 (38%) and 5 patients (9%), respectively. Remission rates were 60% for microprolactinomas and 44% for macroprolactinomas, whereas both giant prolactinomas had persistent disease. No male patient achieved biochemical remission, whereas remission was observed in 29 of 47 women (62%). This observation is exploratory: 6 of the 8 men harboured a macro- or giant prolactinoma and their median preoperative prolactin level was 848.7 ng/mL, against 136.4 ng/mL in women. Transient diabetes insipidus occurred in 9% of patients, whereas permanent complications were uncommon.

Conclusions: In this highly selected surgical cohort, transsphenoidal surgery was followed by durable endocrine control in approximately half of the patients and by a low recurrence rate. These descriptive findings are compatible with a role for surgery as a second-line option, but do not allow inference about its comparative effectiveness.

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经蝶窦手术治疗催乳素瘤的长期内分泌预后：一项20年单中心队列研究

背景：在多巴胺激动剂治疗的时代，经蝶窦手术在泌乳素瘤治疗中的作用仍然存在争议。本描述性研究在一个高度选定的单中心手术队列中评估了经蝶窦手术的长期内分泌预后。方法：我们回顾性分析了1995年9月至2015年7月在三级转诊中心接受经蝶窦手术治疗催乳素瘤的所有患者。生化缓解定义为术后6个月血清催乳素水平正常化。在长期随访中评估疾病的持续性和复发。分析是描述性的，所有亚组比较都是探索性的。结果：纳入55例患者（女性47例，男性8例，中位年龄30岁），其中微催乳素瘤35例（64%），巨催乳素瘤18例（33%），巨催乳素瘤2例（3%）。中位随访时间为10.8年。29例患者（53%）在6个月时达到生化缓解，而21例患者（38%）和5例患者（9%）分别观察到持续疾病和复发。微催乳素瘤缓解率为60%，巨催乳素瘤缓解率为44%，而两种巨催乳素瘤均有持续性疾病。没有男性患者达到生化缓解，而47名女性患者中有29人（62%）达到缓解。这一观察结果是探索性的：8名男性中有6名患有大或巨大的催乳素瘤，他们的术前催乳素水平中位数为848.7 ng/mL，而女性为136.4 ng/mL。9%的患者发生短暂性尿崩症，而永久性并发症并不常见。结论：在这个经过精心挑选的手术队列中，大约一半的患者在经蝶窦手术后进行了持久的内分泌控制，复发率很低。这些描述性发现与手术作为二线选择的作用是一致的，但不允许对其比较有效性进行推断。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pituitary 医学-内分泌学与代谢

CiteScore

7.10

自引率

7.90%

发文量

审稿时长

6 months

期刊介绍： Pituitary is an international publication devoted to basic and clinical aspects of the pituitary gland. It is designed to publish original, high quality research in both basic and pituitary function as well as clinical pituitary disease. The journal considers: Biology of Pituitary Tumors Mechanisms of Pituitary Hormone Secretion Regulation of Pituitary Function Prospective Clinical Studies of Pituitary Disease Critical Basic and Clinical Reviews Pituitary is directed at basic investigators, physiologists, clinical adult and pediatric endocrinologists, neurosurgeons and reproductive endocrinologists interested in the broad field of the pituitary and its disorders. The Editorial Board has been drawn from international experts in basic and clinical endocrinology. The journal offers a rapid turnaround time for review of manuscripts, and the high standard of the journal is maintained by a selective peer-review process which aims to publish only the highest quality manuscripts. Pituitary will foster the publication of creative scholarship as it pertains to the pituitary and will provide a forum for basic scientists and clinicians to publish their high quality pituitary-related work.