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Updated: Mar 15, 2026
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Long-term outcome of macroprolactinomas
Lori Képénékian1, Hélène Cebula2, Frédéric Castinetti3
1Service de médecine interne, nutrition et endocrinologie, hôpital de Hautepierre, University Hospital of Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France.
Objective:
Management of macroprolactinomas has dramatically changed in recent decades, from surgical to medical treatment as first-line therapy, with the development of dopamine agonists (DA). But few data exist on the long-term outcome of these patients.
Patients And Methods:
Retrospective descriptive multicenter study of patients with macroprolactinoma followed for at least 5 years between 1973 and 2008 at the University Hospitals of Strasbourg and Marseille.
Results:
Forty-eight patients were included with 27 men, hypopituitarism in 33.3% of all patients and mean serum prolactin (PRL) level at diagnosis 2218.2±4154.7μg/L. Among the patients, 58.3% received medical treatment, 25% had additional surgery and 12.5% surgery and radiotherapy. The mean follow-up duration was 196±100 months. At the end of follow-up, 10 patients (20.8%) were cured (i.e. normal PRL level and normal imaging, no symptoms and withdrawal of DA≥1 year), 33 (68.8%) were controlled (i.e. normal PRL level, normal or abnormal imaging, no symptoms, DA in progress) and 5 (10.4%) were uncontrolled. Uncontrolled patients had significant higher baseline PRL level (P=0.0412) and cabergoline cumulative dose (P=0.0065) compared to the controlled group. There was no increase in frequency of hypopituitarism. Clinically significant valvular heart disease was found in 2 patients but screening was not systematic.
Conclusions:
Macroprolactinoma is currently most often a chronic disease controlled with DA. However, uncertainty about the adverse effects associated with high cumulative doses and the lack of data on the prognosis at very long-term should incite to revisit current strategies, including the role of surgery combined to medical treatment.
Insights
Dopamine agonists (DA) effectively manage macroprolactinomas, a chronic condition. Long-term outcomes show most patients achieve control, but potential adverse effects necessitate revisiting treatment strategies for optimal prognosis.
Area of Science:
- Endocrinology
- Oncology
- Neurosurgery
Background:
- Macroprolactinomas, large pituitary tumors secreting prolactin, have seen a shift in management from surgery to dopamine agonists (DA).
- Limited data exist on the long-term outcomes of patients with macroprolactinomas treated with DA.
Purpose of the Study:
- To evaluate the long-term outcomes of macroprolactinoma management.
- To assess the efficacy and safety of dopamine agonists in a large cohort over an extended period.
Main Methods:
- A retrospective, descriptive, multicenter study included 48 patients with macroprolactinoma.
- Patients were followed for a minimum of 5 years (mean follow-up: 196 months) between 1973 and 2008.
- Data included baseline characteristics, treatment modalities (medical, surgical, radiotherapy), and long-term outcomes.
Main Results:
- At long-term follow-up, 20.8% of patients were cured, 68.8% were controlled, and 10.4% remained uncontrolled.
- Uncontrolled macroprolactinomas were associated with higher baseline prolactin levels and cumulative cabergoline doses.
- No significant increase in hypopituitarism was observed; two patients developed valvular heart disease.
Conclusions:
- Macroprolactinoma is often a chronic disease manageable with dopamine agonists.
- Uncertainty regarding long-term adverse effects of high cumulative DA doses warrants re-evaluation of current treatment strategies.
- The role of combined surgical and medical treatment for macroprolactinomas requires further investigation.
