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Endocrine Abstracts (2019) 63 GP172 | DOI: 10.1530/endoabs.63.GP172

CHU, Lyon, France.


Introduction: Dopamine agonists (DA), reference treatment for microprolactinomas, rarely allow long term remission. The performance of endoscopic pituitary surgery should be examined as first-line treatment.

Objective: To evaluate the remission rate of microprolactinoma operated by endoscopic transphenoidal approach

Methods: We retrospectively studied the surgical results of the 35 microprolactinomas operated between 2010 to 2017 in our institution by a single surgeon (EJ). We analyzed the immediate (3months) and long term (last follow-up) remission rates, as well as the post-operative complications.

Results: The sex ratio was 7.8 (F=31) and the mean age at diagnosis was 27±8 years. Seven patients were immediately operated (patient choice), 28 received pre-operative DA (median 7.5 (0.2–188) months)) with cabergoline (n=17), quinagolide (n=6), bromocriptine (n=3), or indetermined (n=2). DA achieved prolactin normalization in 13/28 patients (46%). Surgical indication was DA intolerance (n=13), patient choice (n=13), resistance despite DA high dose (n=2). Most of adenomas were noninvasive for cavernous or sphenoid sinus (34/35) and non-proliferative (grade 1a n=26/35). No patient presented pituitary deficiency after surgery. Two presented hyponatremia due to SIADH with spontaneous resolutions in few days. Other complications included sinusitis (n=3) and one cerebral fluid leak without meningitis. At 3-months (n=33), remission rate was 97% (32/33): one patient, intolerant to high dose DA, with 9 mm invasive tumour before surgery, required post-operative Cabergoline treatment (0.5 mg/day). Long term remission rate (n=33) after a median follow-up of 1.3 year [0.25; 9.4] was 81.8% (27/33). Only two patients required DA to control clinical symptoms, 3 presented slight elevation of prolactin level without clinical symptoms or tumor recurrence. The median time before recurrence was 5.4 years [0.7; 9.4]. All women (29) recovered a normal gonadotropic function, allowing 6 pregnancies in 5 patients. Sex, age at diagnosis, pre-operative DA,prolactin level, tumor size, cavernous sinus invasion (radiological or operative) and grade tumor were not significantly associated with long-term remission using univariate analysis. However, all recurrent patients were DA pretreated.

Conclusion: This study showed a high long term remission rate compared to the rate of prolactin normalization under medical treatment, while post-operative complications were acceptable. Surgery could be considered as first line treatment in microplactinomas. Remission rate being higher without preoperative DA, surgery may be proposed before any medical treatment.

Volume 63

21st European Congress of Endocrinology

Lyon, France
18 May 2019 - 21 May 2019

European Society of Endocrinology 

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