The following is a summary of “Presurgical Medical Treatment in Prolactinomas: Surgical Implications and Pathological Characteristics From 290 Cases,” published in the June 2024 issue of Endocrinology by Chen, et al.

For a study, researchers sought to evaluate the impact of presurgical dopamine agonist (DA) therapy on various perioperative outcomes, surgical morbidities, endocrine outcomes, and pathological characteristics in patients undergoing endoscopic endonasal surgery for prolactinomas.

A retrospective analysis was conducted on 290 cases from a single-center series. Clinical data were collected and analyzed to assess the association between presurgical DA therapy and surgical outcomes. Intratumoral collagen content was assessed using Masson trichrome staining to examine underlying pathological changes.

Patients pretreated with DA exhibited a higher prevalence of tenacious tumor consistency (27.8% vs 9.8%, P < .001) compared to those without prior DA treatment. Additionally, DA-pretreated macroadenomas were associated with increased intraoperative blood loss (200 [100-400] mL vs 175 [100-300] mL; P = .014), prolonged surgical duration (177 ± 95 minutes vs 154 ± 57 minutes; P = .043), and higher rates of surgical morbidities (19.4% vs 8.9%; P = .034). These tumors also demonstrated a higher collagen volume fraction than that of the initial surgery group (23.6 ± 2.2% vs 13.2 ± 2.1%; P = .001), with a close correlation between collagen volume fraction and the cumulative dose of bromocriptine (BRC) in macroadenomas (r = 0.438, P < .001). Notably, DA-pretreated microadenomas exhibited lower initial remission rates than those undergoing initial surgery (86.7% vs 100%, P = .047).

Presurgical BRC therapy presented challenges in endoscopic endonasal surgery for prolactinomas, leading to increased surgical difficulty and inferior endocrine outcomes. Surgeons should consider the potential impact of prior DA therapy on surgical outcomes and tailor management strategies accordingly to optimize patient care.

Reference: academic.oup.com/jcem/article-abstract/109/6/1433/7504794