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Relapse of hyperprolactinemia after transsphenoidal surgery for microprolactinoma: lessons from long-term follow-up
John A Thomson1, Christina E Gray, Graham M Teasdale
1University Department of Medicine, Glasgow Royal Infirmary, Glasgow, Scotland G4 0SF, UK.
Objective:
The long-term results of transsphenoidal surgery for microprolactinoma, with particular reference to the question of permanence of relapse of hyperprolactinemia after biochemical cure, are examined.
Methods:
Patients whose operations were performed in the city of Glasgow, Scotland, by one neurosurgeon (GMT) have been followed up for between 15 and 21 years after surgery was performed.
Results:
Of a cohort of 44 patients with confirmed microprolactinoma at the time of surgery, 8 patients (18.2%) who experienced recurrent hyperprolactinemia postoperatively continued to be monitored. Selective hypophysectomy resulted in normal prolactin levels in all patients initially. Relapse occurred at 2 to 10 years (mean, 5.3 yr) postoperatively, but was permanent in only two patients (4.5%). Of the remaining six patients (13.6%), four (9.1%) became normoprolactinemic after 6 or 7 years' recurrence, and two (4.5%) are now only marginally hyperprolactinemic (prolactin >500 but <700 mU/L) at 15 and 18 years after transsphenoidal hypophysectomy.
Conclusion:
The recurrence of hyperprolactinemia after transsphenoidal surgery for microprolactinoma is not necessarily a permanent feature and does not inevitably indicate operative failure.