ArticleJournal of endocrinological investigation2021
First-line surgery in prolactinomas: lessons from a long-term follow-up study in a tertiary referral center.
Article in Journal of endocrinological investigation, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
32 citing papers in PubMed, 2 syntheses or guidelines pooled it, 46 citations in OpenAlex.
- Quality of life in Prolactinoma: A systematic review.Pituitary · 2024Pooled it
- Clinical and radiological presentation of parasellar ectopic pituitary adenomas: case series and systematic review of the literature.Journal of endocrinological investigation · 2022Pooled it
- Long-term endocrine outcomes of transsphenoidal surgery for prolactinomas: a 20-year single-center cohort study.Pituitary · 2026Article
- Prolactinoma-associated headache: Clinical and radiological correlates and long-term outcomes.Pituitary · 2026Article
- Endoscopic surgery for noninvasive prolactinomas: A large multicenter, single-arm, retrospective study (PRLomaSaR).Endocrine · 2026Article
- Long-term cabergoline use does not predict degree of prolactinoma fibrosis nor significantly impact surgical outcomes.Pituitary · 2026Article
- Article
- Predictors of favorable long-term outcomes in first-line surgery for microprolactinomas.Journal of neuro-oncology · 2025Article
- Gender differences in prolactin thresholds and their association with lactotroph adenoma invasiveness for potential treatment considerations.Scientific reports · 2025Article
- A Narrative Review of Surgery for Prolactinomas: Considerations and Controversies.Journal of clinical medicine · 2025Review
- Outcomes in surgical management of microprolactinomas: an international multi-institutional series.Pituitary · 2025Article
- Cystic versus non-cystic prolactinoma: clinical, hormonal, radiological, and remission outcomes in Basrah.Frontiers in endocrinology · 2025Article
- Macroprolactinoma in an adolescent female with primary amenorrhoea.Endocrinology, diabetes & metabolism case reports · 2024Article
- Characteristics and outcomes of men with erectile dysfunction as the presenting symptom due to a lactotroph adenoma.Acta neurochirurgica · 2024Article
- Morbidities and mortality among hospitalized patients with hypopituitarism: Prevalence, causes and management.Reviews in endocrine & metabolic disorders · 2024Review
- The diagnostic yield of inferior petrosal sinus sampling in Cushing syndrome in the era of ovine CRH shortage.Acta neurochirurgica · 2024Article
- The Effect of Preoperative Cabergoline on Prolactinoma Fibrosis: A Case Series.Journal of neurological surgery reports · 2024Article
- Gender-specific prolactin thresholds to determine prolactinoma size: a novel Bayesian approach and its clinical utility.Frontiers in surgery · 2024Article
- Commentary: Clinical characteristics of male prolactinoma patients mainly presenting with severe obesity and the metabolic response to dopamine agonist therapy.Frontiers in endocrinology · 2024Article
- Surgical Management of Giant Prolactinomas: A Descriptive Study.International journal of endocrinology · 2023Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
10 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
contextAlthough consensus guidelines recommend dopamine agonists (DAs) as the first-line approach in prolactinomas, some patients may opt instead for upfront surgery, with the goal of minimizing the need for continuation of DAs over the long term. While this approach can be recommended in selected patients with a microprolactinoma, the indication for upfront surgery in macroprolactinomas remains controversial, with limited long-term data in large cohorts. We aimed at elucidating whether first-line surgery is equally safe and effective for patients with micro- or macroprolactinomas not extending beyond the median carotid line (i.e., Knosp grade ≤ 1). METHODOLOGY: Retrospective study of patients with prolactinomas Knosp grade ≤ 1 treated with upfront surgery. The primary endpoint was patients' dependence on DAs at last follow-up. The secondary endpoint was postoperative complications. Independent risk factors for long-term dependence on DAs were analyzed.
resultsA microadenoma was noted in 45 patients (52%) and a macroadenoma in 41 (48%), with 17 (20%) harboring a Knosp grade 1 prolactinoma. Median follow-up was 80 months. First-line surgery resulted in long-term remission in 31 patients (72%) with a microprolactinoma and in 18 patients (45%) with a macroprolactinoma (p = 0.02). DA therapy was ultimately required in 11 patients (24%) with microadenomas vs. 20 (49%) with macroadenomas (p = 0.03). As for the latter, DA was required in 13 patients (76%) with Knosp grade 1 macroadenomas vs. 7 patients (29%) with Knosp grade 0 macroadenomas (p = 0.004). There was no mortality, and morbidity was minimal. Knosp grade 1 prolactinomas (OR 7.3, 95% CI 1.4-37.7, p = 0.02) but not adenoma size (i.e., macroprolactinomas) were an independent predictor of long-term dependence on DAs.
conclusionsFirst-line surgery in patients with microprolactinomas or macroprolactinomas Knosp grade 0 resulted in a good chance of non-dependency on DA therapy. However, in patients with prolactinomas Knosp grade 1, first-line surgery cannot be recommended, as adjuvant DA therapy after surgery is required in the majority of them over the long term.
Indexed as
Identifiers
What Socratic holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.