Introduction: First-line therapy for prolactin-secreting pituitary adenomas includes medical treatment with dopamine agonists (DA). Transsphenoidal surgery is indicated in patients who are resistant and/or intolerant to DA therapy, or among those presenting with acute symptoms related to mass effect on important neurovascular structures in the parasellar region. These lesions are often loosely organized, and are amenable to gross total tumor resection given their soft consistency. It has been suggested that prolonged DA therapy (>12 months) can convert prolactinomas into more fibrous lesions, rendering them more difficult to completely remove surgically. We performed a retrospective chart review to determine the intraoperative consistency of prolactinomas after prolonged treatment with Cabergoline.
Methods: Medical records from Brigham and Women’s Hospital were retrospectively reviewed for all patients undergoing transsphenoidal surgery for prolactinoma from April 2008 to November 2014. Patients who did not receive prolonged therapy with DA as a result of medical intolerance were eliminated from final analysis.
Results: Biochemically and immunohistochemically confirmed prolactin-secreting pituitary adenomas were identified in 22 patients, including 10 (45.5%) patients who received Cabergoline therapy for >12 months duration prior to surgery, and 12 (54.5%) patients with Cabergoline therapy =12 months duration prior to surgery. The two groups were well matched with regard to preoperative presenting symptoms, medical history, radiographic findings, and dose of preoperative Cabergoline therapy (2.1±1.6mg/week versus 2.2±2.0mg/week, P=0.11). Intraoperative assessment of tumor consistency was equivalent between the two groups: among those with prolonged cabergoline therapy, 3 (30.0%) patients were found to have a fibrous tumor during transsphenoidal surgery as opposed to 2 (16.7%) patients among those with short term cabergoline therapy (P=0.45).
Conclusions: Transsphenoidal surgery can provide immediate resolution of hyperprolactinemia as a result of prolactin-secreting pituitary adenomas. Prolonged preoperative DA therapy does not significantly or reliably impact intraoperative assessment of tumor consistency among our cohort of patients.
Patient Care: Prolactinomas are typically treated medically before surgically. It has been hypothesized in the past that pre-operative treatment of prolactinomas with dopamine agonists could alter the intra-operative consistency of the tumor, making gross total resection more difficult. Here we present a series of prolactinoma patients treated pre-operatively with DA to determine the effects of treatment on tumor consistency.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Understand the effects of Cabergoline treatment on prolactinoma consistency.
2) Develop a more thorough understanding of multimodal care of prolactinomas.