Endoscopic Endonasal Surgery for Prolactinomas: Prognostic Factors for Disease Control and Management of Persistent Disease
Bibliographic record
Abstract
Objective: Prolactinomas are the most common type of functioning pituitary neoplasms. The endoscopic endonasal approach (EEA) is currently the state-of-the-art for the surgical treatment of pituitary tumors. However, only a limited number of studies have focused on the results of EEA for the treatment of prolactinomas. To assess the effectiveness of EEA for prolactinoma surgery, analyze surgical indications, identify factors related with disease remission, and present our approach for management of persistent disease. Methods: This retrospective study included 47 prolactinomas operated via EEA in two high-volume academic pituitary centers over 10 years, with a mean follow-up of 59.9 months. The primary endpoints were “early disease remission” (defined as normoprolactinemia within the first three postoperative months without dopamine agonist (DA) treatment) and “last follow-up remission” (defined as normoprolactinemia at last follow-up, irrespective of DA treatment). Patients’ biochemical, clinical, radiological, and treatment parameters were investigated. Results: Resistance and intolerance to DA were indications for surgery in 76.7%. Overall, early disease remission was achieved in 51.1%; while for microprolactinomas and microprolactinomas enclosed by the pituitary in 80% and 100%, respectively. Early disease remission was correlated with female gender ( p = 0.03), lower preoperative PRL levels ( p = 0.014), microadenoma ( p = 0.001), lack of radiological hemorrhage ( p = 0.001), absence of cavernous sinus (CS) invasion ( p < 0.001), and extent of resection (EOR; p <0.001). Biochemical recurrence was recorded in 8.3%. Persistent disease was reported in 48.9% of patients, with 47% of them achieving remission at last follow-up with DA therapy alone. In cases where hyperprolactinemia was severe or the patient remained symptomatic after the pharmacological maneuvers ( n = 6), repeat EEA and/or radiotherapy were utilized, with 66.7% of cases achieving remission. Last follow-up remission was achieved in 74.8% of patients overall, with symptomatic improvement in nearly 95.8%. Factors predicting last follow-up remission were no previous operation ( p = 0.001), absence of CS invasion ( p = 0.01), and EOR ( p < 0.001). Conclusion: EEA is an effective treatment option and could represent a viable alternative for selected cases, such as centrally located microprolactinomas. Surgery alone is unlikely to achieve disease remission in almost half of the cases. However, its application as part of a multidisciplinary approach may lead to long-term disease control in three quarters of patients with significant symptomatic improvement in an even greater proportion. Publication History Article published online: 15 February 2022 © 2022. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".