TY - JOUR
T1 - Medical versus surgical treatment of prolactinomas
T2 - an analysis of treatment outcomes
AU - Rutkowski, Martin J.
AU - Aghi, Manish K.
N1 - Publisher Copyright:
© 2017 Informa UK Limited, trading as Taylor & Francis Group.
PY - 2018/1/2
Y1 - 2018/1/2
N2 - Introduction: Prolactinomas are unique tumors that may go into both hormonal and radiographic remission with dopamine agonist therapy or transsphenoidal surgery. Regardless of modality, the goals of therapy remain the same: (1) biochemical remission, including reduction of prolactin and normalization of sex hormones; (2) radiographic tumor control, with a range including prevention of tumor growth, tumor regression, or complete tumor resolution; (3) resolution of preoperative symptoms, including those that are hormonal or neurologic; and (4) prevention of new hypopituitarism or new neurologic symptoms. Areas covered: In the following review, we performed a search of the literature using keywords ‘prolactinoma,’ ‘dopamine agonist,’ ‘surgery,’ ‘cost-effectiveness,’ ‘recurrence,’ and ‘complication’ to compare the relative merits of medical versus surgical therapy for prolactinoma, including special circumstances such as cystic tumors, pregnant patients, and the cost-effectiveness of different strategies. Expert commentary: Medical therapy can offer a cure, but surgery provides an important adjunct to patients with resistance or intolerance to dopamine agonists, and offers excellent outcomes including when combined with continued postoperative medical therapy. Further head to head comparisons will benefit patients and practitioners weighing the relative risks and benefits of medical and surgical intervention, including the issue of their relative cost-effectiveness.
AB - Introduction: Prolactinomas are unique tumors that may go into both hormonal and radiographic remission with dopamine agonist therapy or transsphenoidal surgery. Regardless of modality, the goals of therapy remain the same: (1) biochemical remission, including reduction of prolactin and normalization of sex hormones; (2) radiographic tumor control, with a range including prevention of tumor growth, tumor regression, or complete tumor resolution; (3) resolution of preoperative symptoms, including those that are hormonal or neurologic; and (4) prevention of new hypopituitarism or new neurologic symptoms. Areas covered: In the following review, we performed a search of the literature using keywords ‘prolactinoma,’ ‘dopamine agonist,’ ‘surgery,’ ‘cost-effectiveness,’ ‘recurrence,’ and ‘complication’ to compare the relative merits of medical versus surgical therapy for prolactinoma, including special circumstances such as cystic tumors, pregnant patients, and the cost-effectiveness of different strategies. Expert commentary: Medical therapy can offer a cure, but surgery provides an important adjunct to patients with resistance or intolerance to dopamine agonists, and offers excellent outcomes including when combined with continued postoperative medical therapy. Further head to head comparisons will benefit patients and practitioners weighing the relative risks and benefits of medical and surgical intervention, including the issue of their relative cost-effectiveness.
KW - Prolactinoma
KW - adenoma
KW - dopamine agonist
KW - pituitary
KW - surgery
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U2 - 10.1080/17446651.2018.1411798
DO - 10.1080/17446651.2018.1411798
M3 - Review article
C2 - 30063440
AN - SCOPUS:85039165181
SN - 1744-6651
VL - 13
SP - 25
EP - 33
JO - Expert Review of Endocrinology and Metabolism
JF - Expert Review of Endocrinology and Metabolism
IS - 1
ER -