Recovery of hypopituitarism in macroprolactinomas: a comparison of medical vs. surgical treatment. Results from a European multicenter study.

Abstract

Context: Macroprolactinomas not only cause hypogonadism, but also other pituitary dysfunctions, like deficiency of adrenocorticotrophic hormone (ACTH) and thyroid-stimulating hormone (TSH). While dopamine agonist treatment shows varying recovery rates of these insufficiencies, surgical outcomes are less studied, and a direct comparison between treatments is lacking.

Objective: To evaluate recovery of pituitary dysfunction in medically vs. surgically treated patients with macroprolactinoma.

Design: Retrospective multicenter study including 104 patients with macroprolactinoma (44 surgically vs. 60 medically treated) with at least two hormonal deficiencies before treatment.

Results: Before surgery, all patients presented with hypogonadotropic hypogonadism, 25 (57%) with ACTH-deficiency, and 32 (73%) with TSH-deficiency. 10 months post-surgery, prolactin normalized in 25 (57%) patients, while 19(43%), 15 (60%) and 10(31%) recovered from hypogonadism, ACTH-deficiency, and TSH-deficiency, respectively. Before medical therapy, hypogonadism was observed in all patients, ACTH-deficiency in 31 (52%), and TSH-deficiency in 50 (83%). After 12 months under dopamine agonists, prolactin levels normalized in 36 (60%) patients, 25(42%) recovered from hypogonadism, 17 (55%) from ACTH-deficiency, and 14(28%) from TSH-deficiency. No significant difference in recovery rates between surgical and medical treatment for hypogonadism (OR 1.633, p = 0.338), ACTH-deficiency (OR 0.462, p = 0.319), or TSH-deficiency (OR 0.584, p = 0.339) was observed. Large initial tumor size was a significant negative predictor of recovery for all hormone deficiencies (always p < 0.05), while prolactin normalization was a predictor of recovery of hypogonadism (p < 0.001).

Conclusion: Both surgical and medical treatment allow for hormonal recovery in patients with macroprolactinoma, with no significant advantage for either approach. Initial tumor size and prolactin-normalization are predictors of recovery outcomes.