Neurosurgery treatment for macroprolactinomas: a retrospective study

Raoua Naouar; Hanene Sayadi; Sana Abid; Ghassen Belkahla; Nsir Atef Ben; Amor Bilel Ben; Ekram Hajji; Ines Bayar; Hela Marmouch; Ines Khochteli; Mahdi Darmoul; Tames Gema Martinez

doi:10.1530/endoabs.99.EP1284

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Endocrine Abstracts (2024) 99 EP1284 | DOI: 10.1530/endoabs.99.EP1284

ECE2024 Eposter Presentations Late Breaking (127 abstracts)

Neurosurgery treatment for macroprolactinomas: a retrospective study

Raoua Naouar ¹ , Hanene Sayadi ¹ , Sana Abid ¹ , Ghassen Belkahla ² , Atef Ben Nsir ² , Bilel Ben Amor ¹ , Ekram Hajji ¹ , Ines Bayar ¹ , Héla Marmouch ¹ , Inès Khochteli ¹ , Mahdi Darmoul ² & Gema Martinez Tames ³

Err

Author affiliations

¹Fattouma Bourguiba Hospital, Endocrinology and Internal Medicine Department, Monastir, Tunisia;²Fattouma Bourguiba Hospital, Neurosurgery Department, Monastir, Tunisia; ³Hospital Valle Del Nalon, Endocrinology Division, Monastir, Tunisia

Introduction: The management of prolactinomas, whatever their size, is based on medical treatment with dopamine agonists (DA). The latter allows clinical improvement with efficient control of prolactin secretion and tumor growth. Pituitary surgery or radiotherapy are adjuvant therapies in case of neurologic complication or lack of response to DA.

Patients and methods: We conducted a monocentric analytic study of patients followed for confirmed prolactinomas at the endocrinology-internal medicine and neurosurgery departments of the Fattouma Bourguiba University Hospital, Monastir, from January 2000 to March 2022.

Results: Among the factors associated with the necessity for surgery, only initial tumor size was correlated with surgical treatment. Indeed, the average initial tumor size in operated patients was 34.5±8.44 mm versus 26.16±12.19 mm in non-operated patients. However, there was no difference in the normalization of prolactin level (90% versus 93%, P=0.4) nor in the rate of reduction in tumor size in response to surgery compared to those under medical treatment (53% versus 57%, P=0.2).

Table 1. Factors related to the use of pituitary surgery
Factors	Surgical managment n=10	p
Gender male	5 (50%)	0.39
Age at diagnosis	38.5±11.78	0.66
Prolactin level (ng/ml)	639.9	0.09
Initial tumor size (mm)	34.5±8.44	0.02
Pituitary apoplexy	2 (20%)	0.12
Tumor invasion	6 (60%)	0.79
T2-weighted MRI signal
Hypersignal	8 (80%)	0.35
Hyposignal	1 (10%)	0.23
Isosignal	1 (10%)	0.21

Conclusion: DA have traditionally been the primary treatment for the majority of prolactinomas, with surgery considered the second line therapy. Complete surgical removal of invasive macroprolactinomas is technically difficult and structural healing is rare and is not without risks. It should be reserved for cases of inadequate response to medical therapy or in cases of emergency.