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Multicenter Study
. 2025 Feb 3;28(1):28.
doi: 10.1007/s11102-025-01497-1.

Outcomes in surgical management of microprolactinomas: an international multi-institutional series

Danielle Golub  1   2 , Timothy G White  3 , Harshal A Shah  3 , Mehdi Khaleghi  4 , Kristin M Huntoon  4 , Ingrid M Zandbergen  5   6 , Leontine E H Bakker  6 , Luma M Ghalib  7 , Iris C M Pelsma  6 , Ehsan Dowlati  3 , Mark B Chaskes  8 , Judd H Fastenberg  8 , Marco J T Verstegen  5 , Nienke R Biermasz  6 , Daniel M Prevedello  4 , Amir R Dehdashti  3   8
Affiliations
Multicenter Study

Outcomes in surgical management of microprolactinomas: an international multi-institutional series

Danielle Golub et al. Pituitary. .

Abstract

Background: Prolactinomas represent the most common pituitary adenoma subtype, the majority of which are microprolactinomas. Dopamine agonists (DAs) remain the first-line intervention for microprolactinomas, however, many patients either cannot tolerate DAs or require lifelong therapy to maintain hormonal control. As endoscopic endonasal surgery (EES) continues to revolutionize the surgical management of sellar lesions, we sought to reassess the feasibility and efficacy of early surgical resection for microprolactinoma.

Methods: Retrospective chart review from 2010 to 2021 of adults who underwent EES for microprolactinoma was performed across three medical centers. Surgical failure was defined as a need to restart DAs, a serum prolactin level greater than 30ng/mL at last follow-up, tumor recurrence, or a need for reoperation.

Results: A total of 56 patients were identified with a mean age of 32.9 years and an average of 26.4 months of follow-up. The majority had been on DAs preoperatively (98.2%). The most common surgical indications were DA intolerance (73.2%), tumor unresponsiveness (19.6%), and desire for pregnancy (7.1%). Gross total resection was achieved in 51 (91.1%) cases. The overall surgical remission rate was approximately 70% with failures observed in 17 (30.4%) patients. Multivariate logistic regression identified subtotal resection as the only independent predictor of surgical failure (p = 0.038*). The most common postoperative complication was transient arginine vasopressin deficiency (AVP-D) (21.4%). There were no cases of permanent AVP-D, new visual deficits, or cerebrospinal fluid leak.

Conclusions: With a surgical remission rate of nearly 70%, EES represents a safe and viable alternative strategy to long-term DA treatment for microprolactinomas.

Keywords: Dopamine agonist; Endoscopic endonasal surgery; Microprolactinoma; Pituitary adenoma; Prolactin.

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Conflict of interest statement

Declarations. Ethics Statement: Institutional Review Board (IRB) approval for this multi-center retrospective chart review study to review individual patient charts for data capture was obtained by the lead author under the guidelines set forth by the Northwell Health Human Research Protection Program. A data-sharing agreement was established for anonymized data sharing across the three involved medical centers. Given the retrospective nature of the research and supervised anonymization process for data collection under IRB guidelines, individual patient consent to participate and consent to publish were not required. All authors contributed sufficiently to the development of this work and have approved of its submission to Pituitary. This manuscript is a unique submission and is not being considered for publication, in part or in full, with any other source in any medium. This work received no funding or other material supplementation, and there are no conflicts of interest to disclose. This work was performed with ethical approval from the institutional review boards of the three participating centers in accordance with the declaration of Helsinki. Competing interests: The authors declare no competing interests.

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