Phẫu thuật hàng đầu trong các khối u tiết prolactin: bài học từ một nghiên cứu theo dõi lâu dài tại một trung tâm chuyển tuyến

Journal of Endocrinological Investigation - 2021
Lukas Andereggen1, Janine Frey2, Robert H. Andres1, Markus M. Luedi3, Marwan El-Koussy4, Hans Rudolf Widmer1, Jürgen Beck1, Luigi Mariani5, Rolf W. Seiler1, Emanuel Christ6
1Department of Neurosurgery, Neurocenter and Regenerative Neuroscience Cluster, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
2Department of Endocrinology, Diabetes, Nutrition and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
3Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
4Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
5Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland
6Department of Endocrinology, Diabetes and Metabolism, University Hospital of Basel, Basel, Switzerland

Tóm tắt

Tóm tắtBối cảnhMặc dù các hướng dẫn đồng thuận khuyến nghị các tác nhân kích thích dopamine (DA) là phương pháp đầu tay trong điều trị các khối u tiết prolactin, một số bệnh nhân có thể lựa chọn phẫu thuật ngay từ đầu với mục tiêu giảm thiểu nhu cầu tiếp tục điều trị DA trong thời gian dài. Trong khi phương pháp này có thể được khuyến nghị cho những bệnh nhân chọn lọc có khối u prolactin nhỏ, việc chỉ định phẫu thuật ngay từ đầu trong các khối u prolactin lớn vẫn còn gây tranh cãi, với dữ liệu dài hạn hạn chế từ các nhóm bệnh nhân lớn. Chúng tôi nhằm làm rõ liệu phẫu thuật hàng đầu có đảm bảo an toàn và hiệu quả tương đương cho các bệnh nhân với khối u prolactin nhỏ hoặc lớn không vượt quá đường trung bình động mạch cảnh (tức là, cấp độ Knosp ≤ 1). Phương phápNghiên cứu hồi cứu trên các bệnh nhân có khối u prolactin đạt cấp độ Knosp ≤ 1 điều trị bằng phẫu thuật ngay từ đầu. Điểm cuối chính là mức độ phụ thuộc vào DA của bệnh nhân tại lần theo dõi cuối cùng. Điểm cuối thứ cấp là các biến chứng hậu phẫu. Các yếu tố nguy cơ độc lập cho sự phụ thuộc dài hạn vào DA đã được phân tích.Đặc điểm kết quảMột vi u tuyến đã được ghi nhận ở 45 bệnh nhân (52%) và một đại u tuyến ở 41 (48%), trong đó có 17 (20%) có khối u prolactin cấp độ Knosp 1. Thời gian theo dõi trung bình là 80 tháng. Phẫu thuật đầu tay dẫn đến sự thuyên giảm lâu dài ở 31 bệnh nhân (72%) có khối u prolactin nhỏ và ở 18 bệnh nhân (45%) có khối u prolactin lớn (p = 0.02). Cuối cùng, liệu pháp DA đã được yêu cầu cho 11 bệnh nhân (24%) có vi u tuyến so với 20 (49%) có đại u tuyến (p = 0.03). Đối với những khối u sau này, DA đã được yêu cầu ở 13 bệnh nhân (76%) có đại u tuyến Knosp cấp độ 1 so với 7 bệnh nhân (29%) có đại u tuyến Knosp cấp độ 0 (p = 0.004). Không có trường hợp tử vong nào, và tỷ lệ biến chứng là tối thiểu. Khối u tiết prolactin cấp độ Knosp 1 (OR 7.3, 95% CI 1.4–37.7, p = 0.02) nhưng không phải kích thước khối u (tức là các khối u prolactin lớn) là một tiên lượng độc lập về sự phụ thuộc dài hạn vào DA.Kết luậnPhẫu thuật hàng đầu ở bệnh nhân có khối u prolactin nhỏ hoặc khối u prolactin lớn Knosp cấp độ 0 mang lại cơ hội tốt để không cần phụ thuộc vào liệu pháp DA. Tuy nhiên, ở bệnh nhân có khối u prolactin Knosp cấp độ 1, phẫu thuật hàng đầu không thể được khuyến nghị, vì liệu pháp DA hỗ trợ sau phẫu thuật là cần thiết cho phần lớn họ trong thời gian dài.

Từ khóa


Tài liệu tham khảo

Colao A, Di Sarno A, Guerra E et al (2007) Predictors of remission of hyperprolactinaemia after long-term withdrawal of cabergoline therapy. Clin Endocrinol 67:426–433. https://doi.org/10.1111/j.1365-2265.2007.02905.x

Kars M, Souverein PC, Herings RM et al (2009) Estimated age- and sex-specific incidence and prevalence of dopamine agonist-treated hyperprolactinemia. J Clin Endocrinol Metab 94:2729–2734. https://doi.org/10.1210/jc.2009-0177

Levy A. Pituitary disease: presentation, diagnosis, and management. J Neurol Neurosurg Psychiatry 2004; 75 Suppl 3: iii47–52 DOI: https://doi.org/10.1136/jnnp.2004.045740

Andereggen L, Mono ML, Kellner-Weldon F et al (2017) Cluster headache and macroprolactinoma: case report of a rare, but potential important causality. J Clin Neurosci 40:62–64. https://doi.org/10.1016/j.jocn.2017.01.028

Primeau V, Raftopoulos C, Maiter D (2012) Outcomes of transsphenoidal surgery in prolactinomas: improvement of hormonal control in dopamine agonist-resistant patients. Euro J Endocrinol / Euro Federation Endocrine Soc 166:779–786. https://doi.org/10.1530/EJE-11-1000

Oh MC, Aghi MK (2011) Dopamine agonist-resistant prolactinomas. J Neurosurg 114:1369–1379. https://doi.org/10.3171/2010.11.JNS101369

Ma Q, Su J, Li Y et al (2018) The chance of permanent cure for micro- and macroprolactinomas, medication or surgery? A systematic review and meta-analysis. Front Endocrinol (Lausanne) 9:636. https://doi.org/10.3389/fendo.2018.00636

Zamanipoor Najafabadi AH, Zandbergen IM, de Vries F et al. Surgery as a viable alternative first-line treatment for prolactinoma patients. A systematic review and meta-analysis. The Journal of clinical endocrinology and metabolism 2019: DOI: https://doi.org/10.1210/clinem/dgz144

Ogiwara T, Horiuchi T, Nagm A et al (2017) Significance of surgical management for cystic prolactinoma. Pituitary 20:225–230. https://doi.org/10.1007/s11102-016-0766-6

Donoho DA, Laws ER Jr (2019) The role of surgery in the management of prolactinomas. Neurosurg Clin N Am 30:509–514. https://doi.org/10.1016/j.nec.2019.05.010

Vasilev V, Daly AF, Vroonen L et al (2011) Resistant prolactinomas. J Endocrinol Invest 34:312–316. https://doi.org/10.3275/760410.1007/BF03347092

Song YJ, Chen MT, Lian W et al (2017) Surgical treatment for male prolactinoma: a retrospective study of 184 cases. Medicine (Baltimore) 96:e5833. https://doi.org/10.1097/MD.0000000000005833

Casanueva FF, Molitch ME, Schlechte JA et al (2006) Guidelines of the pituitary society for the diagnosis and management of prolactinomas. Clin Endocrinol 65:265–273. https://doi.org/10.1111/j.1365-2265.2006.02562.x

Dekkers OM, Lagro J, Burman P et al (2010) Recurrence of hyperprolactinemia after withdrawal of dopamine agonists: systematic review and meta-analysis. J Clin Endocrinol Metab 95:43–51. https://doi.org/10.1210/jc.2009-1238

Verhelst J, Abs R, Maiter D et al (1999) Cabergoline in the treatment of hyperprolactinemia: a study in 455 patients. J Clin Endocrinol Metab 84:2518–2522. https://doi.org/10.1210/jcem.84.7.5810

Webster J, Piscitelli G, Polli A et al. A comparison of cabergoline and bromocriptine in the treatment of hyperprolactinemic amenorrhea. Cabergoline Comparative Study Group. The New England journal of medicine 1994; 331: 904–909 DOI: https://doi.org/10.1056/NEJM199410063311403

Herring N, Szmigielski C, Becher H et al (2009) Valvular heart disease and the use of cabergoline for the treatment of prolactinoma. Clin Endocrinol 70:104–108. https://doi.org/10.1111/j.1365-2265.2008.03458.x

Zanettini R, Antonini A, Gatto G et al (2007) Valvular heart disease and the use of dopamine agonists for Parkinson’s disease. N Engl J Med 356:39–46. https://doi.org/10.1056/NEJMoa054830

Stiles CE, Tetteh-Wayoe ET, Bestwick J et al. A meta-analysis of the prevalence of cardiac valvulopathy in hyperprolactinemic patients treated with Cabergoline. The Journal of clinical endocrinology and metabolism 2018: DOI: https://doi.org/10.1210/jc.2018-01071

Stiles CE, Lloyd G, Bhattacharyya S et al (2021) Incidence of cabergoline-associated valvulopathy in primary care patients with prolactinoma using hard cardiac endpoints. J Clin Endocrinol Metab 106:e711–e720. https://doi.org/10.1210/clinem/dgaa882

Moore TJ, Glenmullen J, Mattison DR (2014) Reports of pathological gambling, hypersexuality, and compulsive shopping associated with dopamine receptor agonist drugs. JAMA Intern Med 174:1930–1933. https://doi.org/10.1001/jamainternmed.2014.5262

Weiss HD, Pontone GM (2014) Dopamine receptor agonist drugs and impulse control disorders. JAMA Intern Med 174:1935–1937. https://doi.org/10.1001/jamainternmed.2014.4097

Bancos I, Nannenga MR, Bostwick JM et al (2014) Impulse control disorders in patients with dopamine agonist-treated prolactinomas and nonfunctioning pituitary adenomas: a case-control study. Clin Endocrinol 80:863–868. https://doi.org/10.1111/cen.12375

Ioachimescu AG, Fleseriu M, Hoffman AR et al (2019) Psychological effects of dopamine agonist treatment in patients with hyperprolactinemia and prolactin-secreting adenomas. Euro J Endocrinol / Euro Federation Endocrine Soc 180:31–40. https://doi.org/10.1530/EJE-18-0682

Andereggen L, Frey J, Christ E. Long-term IGF-1 monitoring in prolactinoma patients treated with cabergoline might not be indicated. Endocrine 2020: DOI: https://doi.org/10.1007/s12020-020-02557-1

Castinetti F, Albarel F, Amodru V et al (2021) The risks of medical treatment of prolactinoma. Ann Endocrinol 82:15–19. https://doi.org/10.1016/j.ando.2020.12.008

Tampourlou M, Trifanescu R, Paluzzi A et al (2016) THERAPY OF ENDOCRINE DISEASE: Surgery in microprolactinomas: effectiveness and risks based on contemporary literature. Euro J Endocrinol / Euro Federation Endocrine Soc 175:R89-96. https://doi.org/10.1530/EJE-16-0087

Babey M, Sahli R, Vajtai I et al (2011) Pituitary surgery for small prolactinomas as an alternative to treatment with dopamine agonists. Pituitary 14:222–230. https://doi.org/10.1007/s11102-010-0283-y

Micko A, Vila G, Hoftberger R et al (2019) Endoscopic transsphenoidal surgery of microprolactinomas: a reappraisal of cure rate based on radiological criteria. Neurosurgery 85:508–515. https://doi.org/10.1093/neuros/nyy385

Andereggen L, Frey J, Andres RH et al (2017) Long-term follow-up of primary medical versus surgical treatment of prolactinomas in men: effects on hyperprolactinemia, hypogonadism, and bone health. World Neurosurg 97:595–602. https://doi.org/10.1016/j.wneu.2016.10.059

Andereggen L, Frey J, Andres RH et al. 10-year follow-up study comparing primary medical vs. surgical therapy in women with prolactinomas. Endocrine 2017; 55: 223–230 DOI: https://doi.org/10.1007/s12020-016-1115-2

Kepenekian L, Cebula H, Castinetti F et al (2016) Long-term outcome of macroprolactinomas. Ann Endocrinol 77:641–648. https://doi.org/10.1016/j.ando.2016.07.004

Green AI, Sherlock M, Stewart PM et al (2014) Extensive experience in the management of macroprolactinomas. Clin Endocrinol 81:85–92. https://doi.org/10.1111/cen.12418

Andereggen L, Frey J, Andres RH et al (2021) Persistent bone impairment despite long-term control of hyperprolactinemia and hypogonadism in men and women with prolactinomas. Sci Rep 11:5122. https://doi.org/10.1038/s41598-021-84606-x

Karavitaki N, Thanabalasingham G, Shore HC et al (2006) Do the limits of serum prolactin in disconnection hyperprolactinaemia need re-definition? A study of 226 patients with histologically verified non-functioning pituitary macroadenoma. Clin Endocrinol 65:524–529. https://doi.org/10.1111/j.1365-2265.2006.02627.x

Cattaneo F, Kappeler D, Muller B. Macroprolactinaemia, the major unknown in the differential diagnosis of hyperprolactinaemia. Swiss medical weekly 2001; 131: 122-126 DOI: 2001/09/smw-06127

Melmed S, Casanueva FF, Hoffman AR et al (2011) Diagnosis and treatment of hyperprolactinemia: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 96:273–288. https://doi.org/10.1210/jc.2010-1692

Andereggen L, Gralla J, Schroth G et al (2021) Influence of inferior petrosal sinus drainage symmetry on detection of adenomas in Cushing’s syndrome. J Neuroradiol 48:10–15. https://doi.org/10.1016/j.neurad.2019.05.004

Andereggen L, Schroth G, Gralla J et al (2012) Selective inferior petrosal sinus sampling without venous outflow diversion in the detection of a pituitary adenoma in Cushing’s syndrome. Neuroradiology 54:495–503. https://doi.org/10.1007/s00234-011-0915-6

Knosp E, Steiner E, Kitz K et al. Pituitary adenomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings. Neurosurgery 1993; 33: 610–617; discussion 617–618 DOI: https://doi.org/10.1227/00006123-199310000-00008

Micko AS, Wohrer A, Wolfsberger S et al (2015) Invasion of the cavernous sinus space in pituitary adenomas: endoscopic verification and its correlation with an MRI-based classification. J Neurosurg 122:803–811. https://doi.org/10.3171/2014.12.JNS141083

Lopes MBS (2017) The 2017 World Health Organization classification of tumors of the pituitary gland: a summary. Acta Neuropathol 134:521–535. https://doi.org/10.1007/s00401-017-1769-8

Kruljac I, Kirigin LS, Strinovic M et al (2015) Treatment of prolactinomas in low-income countries. Int J Endocrinol 2015:697065. https://doi.org/10.1155/2015/697065

Seiler RW, Mariani L (2000) Sellar reconstruction with resorbable vicryl patches, gelatin foam, and fibrin glue in transsphenoidal surgery: a 10-year experience with 376 patients. J Neurosurg 93:762–765. https://doi.org/10.3171/jns.2000.93.5.0762

Arduc A, Gokay F, Isik S et al (2015) Retrospective comparison of cabergoline and bromocriptine effects in hyperprolactinemia: a single center experience. J Endocrinol Invest 38:447–453. https://doi.org/10.1007/s40618-014-0212-4

Wass JA (2006) When to discontinue treatment of prolactinoma? Nat Clin Pract Endocrinol Metab 2:298–299. https://doi.org/10.1038/ncpendmet0162

Colao A, Di Sarno A, Cappabianca P et al (2003) Withdrawal of long-term cabergoline therapy for tumoral and nontumoral hyperprolactinemia. N Engl J Med 349:2023–2033. https://doi.org/10.1056/NEJMoa022657

Eroukhmanoff J, Tejedor I, Potorac I et al (2017) MRI follow-up is unnecessary in patients with macroprolactinomas and long-term normal prolactin levels on dopamine agonist treatment. Euro J Endocrinol / Euro Federation Endocrine Soc 176:323–328. https://doi.org/10.1530/EJE-16-0897

Varlamov EV, Hinojosa-Amaya JM, Fleseriu M. Magnetic resonance imaging inthe management of prolactinomas; a review of the evidence. Pituitary 2019: DOI: https://doi.org/10.1007/s11102-019-01001-6

Molitch ME (2017) Diagnosis and treatment of pituitary adenomas: a review. JAMA 317:516–524. https://doi.org/10.1001/jama.2016.19699

Demartini B, Ricciardi L, Ward A et al (2014) Dopamine agonist withdrawal syndrome (DAWS) in a patient with a microprolactinoma. J Neurol Neurosurg Psychiatry 85:471. https://doi.org/10.1136/jnnp-2013-306043

Honegger J, Nasi-Kordhishti I, Aboutaha N et al (2020) Surgery for prolactinomas: a better choice? Pituitary 23:45–51. https://doi.org/10.1007/s11102-019-01016-z

Landolt AM, Keller PJ, Froesch ER et al (1982) Bromocriptine: Does it jeopardise the result of later surgery for prolactinomas? Lancet 2:657–658. https://doi.org/10.1016/s0140-6736(82)92756-8

Menucci M, Quinones-Hinojosa A, Burger P et al (2011) Effect of dopaminergic drug treatment on surgical findings in prolactinomas. Pituitary 14:68–74. https://doi.org/10.1007/s11102-010-0261-4

Donegan D, Atkinson JL, Jentoft M et al (2017) Surgical outcomes of prolactinomas in recent era: results of a heterogenous group. Endocr Pract 23:37–45. https://doi.org/10.4158/EP161446.OR

Landolt AM, Osterwalder V (1984) Perivascular fibrosis in prolactinomas: is it increased by bromocriptine? J Clin Endocrinol Metab 58:1179–1183. https://doi.org/10.1210/jcem-58-6-1179

Button KS, Ioannidis JP, Mokrysz C et al (2013) Power failure: why small sample size undermines the reliability of neuroscience. Nat Rev Neurosci 14:365–376. https://doi.org/10.1038/nrn3475

Lobatto DJ, Steffens ANV, Zamanipoor Najafabadi AH et al (2018) Work disability and its determinants in patients with pituitary tumor-related disease. Pituitary 21:593–604. https://doi.org/10.1007/s11102-018-0913-3

Uvelius E, Castelo N, Kahlon B et al (2017) Quality of life and work capacity are unrelated to approach or complications after pituitary surgery. World neurosurgery 108:24–32. https://doi.org/10.1016/j.wneu.2017.08.087

Vega-Beyhart A, Enriquez-Estrada VM, Bello-Chavolla OY et al (2019) Quality of life is significantly impaired in both secretory and non-functioning pituitary adenomas. Clin Endocrinol (Oxf) 90:457–467. https://doi.org/10.1111/cen.13915

van der Meulen M, Zamanipoor Najafabadi AH, Lobatto DJ et al (2021) Healthcare utilization and costs among prolactinoma patients: a cross-sectional study and analysis of determinants. Pituitary 24:79–95. https://doi.org/10.1007/s11102-020-01089-1

Jethwa PR, Patel TD, Hajart AF et al (2016) Cost-effectiveness analysis of microscopic and endoscopic transsphenoidal surgery versus medical therapy in the management of microprolactinoma in the United States. World neurosurgery 87:65–76. https://doi.org/10.1016/j.wneu.2015.10.090

Tabaee A, Anand VK, Barron Y et al (2009) Endoscopic pituitary surgery: a systematic review and meta-analysis. J Neurosurg 111:545–554. https://doi.org/10.3171/2007.12.17635

Zatelli MC, Ambrosio MR, Bondanelli M et al (2007) Control of pituitary adenoma cell proliferation by somatostatin analogs, dopamine agonists and novel chimeric compounds. Euro J Endocrinol / Euro Federation Endocrine Soc 156(Suppl 1):S29–S35. https://doi.org/10.1530/eje.1.02352

Lafeber M, Stades AM, Valk GD et al (2010) Absence of major fibrotic adverse events in hyperprolactinemic patients treated with cabergoline. Euro J Endocrinol / Euro Federation Endocrine Soc 162:667–675. https://doi.org/10.1530/EJE-09-0989

Drake WM, Stiles CE, Howlett TA et al (2014) A cross-sectional study of the prevalence of cardiac valvular abnormalities in hyperprolactinemic patients treated with ergot-derived dopamine agonists. J Clin Endocrinol Metab 99:90–96. https://doi.org/10.1210/jc.2013-2254

Han YL, Chen DM, Zhang C et al (2018) Retrospective analysis of 52 patients with prolactinomas following endoscopic endonasal transsphenoidal surgery. Medicine (Baltimore) 97:e13198. https://doi.org/10.1097/MD.0000000000013198

Ono M, Miki N, Kawamata T et al (2008) Prospective study of high-dose cabergoline treatment of prolactinomas in 150 patients. J Clin Endocrinol Metab 93:4721–4727. https://doi.org/10.1210/jc.2007-2758

Schlechte JA (2007) Long-term management of prolactinomas. J Clin Endocrinol Metab 92:2861–2865. https://doi.org/10.1210/jc.2007-0836

Sosa-Eroza E, Espinosa E, Ramirez-Renteria C et al (2018) Treatment of multiresistant prolactinomas with a combination of cabergoline and octreotide LAR. Endocrine 61:343–348. https://doi.org/10.1007/s12020-018-1638-9

Kwancharoen R, Auriemma RS, Yenokyan G et al (2014) Second attempt to withdraw cabergoline in prolactinomas: a pilot study. Pituitary 17:451–456. https://doi.org/10.1007/s11102-013-0525-x

Xia MY, Lou XH, Lin SJ et al (2018) Optimal timing of dopamine agonist withdrawal in patients with hyperprolactinemia: a systematic review and meta-analysis. Endocrine 59:50–61. https://doi.org/10.1007/s12020-017-1444-9

Sala E, Bellaviti Buttoni P, Malchiodi E et al (2016) Recurrence of hyperprolactinemia following dopamine agonist withdrawal and possible predictive factors of recurrence in prolactinomas. J Endocrinol Invest 39:1377–1382. https://doi.org/10.1007/s40618-016-0483-z

Bunevicius A, Laws ER, Vance ML et al (2019) Surgical and radiosurgical treatment strategies for Cushing’s disease. J Neurooncol 145:403–413. https://doi.org/10.1007/s11060-019-03325-6

Honegger J, Grimm F (2018) The experience with transsphenoidal surgery and its importance to outcomes. Pituitary 21:545–555. https://doi.org/10.1007/s11102-018-0904-4

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