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Comparison of the effects of medical and surgical treatments in giant prolactinoma: a single-center experience

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Abstract

Purpose

Giant prolactinomas, which have extremely large sizes and high prolactin (PRL) values, are rarely seen. Although medical therapy is effective, surgical treatment is more frequently applied due to slightly lower response rates and compression symptoms. This study aimed to compare the medical and surgical treatment results in giant prolactinomas.

Methods

Thirty-nine patients who were followed up in our center for giant prolactinoma were included in the study, and the response rates of the patients were evaluated after the medical and surgical treatments. The treatment responses were compared in terms of tumor volume, PRL level, visual field, and pituitary function.

Results

The outcomes of the 66 treatment periods (medical n = 42; surgical n = 24) in 39 patients (mean age, 47.2 years; men, 89.7%) were evaluated. The most common presentations were hypogonadism and visual defects. The mean longest tumor diameter at diagnosis was 52.2 ± 11.8 mm, and the median PRL levels were 5000 ng/mL. PRL level normalization was achieved in 69% with medical therapy, and a curative response was obtained in only two patients with surgery. Tumor volume reduction was 67% (no cure) in the medical and 75% (13% cure) in the surgical groups (p = 0.39). Improvement of visual field was 70.8% in the medical and 84.2% in the surgical group (p = 0.12).

Conclusion

In our study, it was observed that medical therapy was effective and safe in patients with giant prolactinomas. The use of surgical treatment should be limited to prolactinomas with compression or post-resistance to medical treatment in serious cases.

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Data availability

The data used to support the findings of this study are available from the corresponding author upon request.

Code availability

Software licence is available for use in Bursa Uludag University network.

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Acknowledgements

An English language revision of this article was supported by the Society of Endocrinology and Metabolism of Turkey.

Author information

Authors and Affiliations

  1. Endocrinology and Metabolism, Bursa Uludag University Medical School, Bursa, Turkey

    Soner Cander, Ozen Oz Gul & Canan Ersoy

  2. Internal Medicine, Bursa Uludag University Medical School, Bursa, Turkey

    Eda Eylemer & Elif Gullulu Boz

  3. Endocrinology and Metabolism, Bursa City Hospital, Bursa, Turkey

    Elif Gunes

  4. Bursa Uludag University Medical School, Neuroradiology, , Turkey

    Bahattin Hakyemez

  5. Bursa Uludag University Medical School, Neurosurgery, , Turkey

    Selcuk Yilmazlar

Authors
  1. Soner Cander
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  2. Ozen Oz Gul
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Contributions

SC developed the concept, and OOG, EE, EGB, and EG collected the anamnesis and biochemical data for each patient from medical records. SC, OOG, and BH examined the MR images in detail to determine tumor volumes and responses. SY collected and analyzed surgical details. SC performed the data analysis and manuscript writing. OOG and CE supervised the manuscript drafting and supervised the findings of this work. CE reviewed and edited the manuscript. All authors discussed the results and contributed to the final manuscript.

Corresponding author

Correspondence to Soner Cander.

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The study was conducted in accordance with guidelines in the Declaration of Helsinki and approved by the Institutional Ethics Committee.

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The authors declare no competing interests.

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Cander, S., Oz Gul, O., Eylemer, E. et al. Comparison of the effects of medical and surgical treatments in giant prolactinoma: a single-center experience. Hormones 20, 491–498 (2021). https://doi.org/10.1007/s42000-021-00307-0

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  • DOI: https://doi.org/10.1007/s42000-021-00307-0

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