2026 Poster Presentations
P211: SHORT- AND LONG-TERM BIOCHEMICAL REMISSION RATES OF SURGICALLY TREATED PROLACTINOMAS
Eric Lassiter, BS1; Thomas Hanks, BS1; Chris Seward, MD1; Tyler Lazaro, MD1; Patrick Bi, BS1; Rya Berrigan, BS1; Jack Sedwick, BA1; Rose Wang, BS1; Kyle Montgomery, BS1; Ivan Brown, BS1; Kyly Hiatt, BA1; Wenxuan Xiong, PhD1; Brent Wisse, MD1; Aria Jafari, MD2; Ian Humphreys, DO2; Waleed Abuzeid, MD2; Manuel Ferreira, MD, PhD1; Samuel Emerson, MD, PhD1; Jacob Ruzevick, MD1; 1University of Washington Department of Neurological Surgery; 2University of Washington Department of Otolaryngology/Head and Neck Surgery
Introduction: Prolactinomas confer significant morbidity because of hyperprolactinemia and mass effect. Dopamine agonist therapy is highly effective at resolving symptomatology and normalizing serum levels of prolactin. Long-term therapy is often required as only one-fifth of patients remain in remission after discontinuation. Recently, transsphenoidal surgery for well-circumscribed prolactinomas without cavernous sinus invasion (Knosp grade 0 and 1) has been recommended as another first-line option given the possibility of surgical remission.
Objective: Assess biochemical remission rates following surgical treatment of all prolactinomas at a single institution.
Methods: An IRB-approved single-center retrospective cohort study of patients who underwent endoscopic endonasal transsphenoidal surgery for resection of prolactinoma between 2011 and 2023 was performed. Patient demographics, perioperative data, and endocrinologic data were obtained using electronic health records. Data analysis and visualization was performed in RStudio (v4.5.0).
Results: A total of 127 patients underwent surgical resection, of which 54% were female. A total of 89 (70.1%) patients had normalization of hyperprolactinemia on post-operative day 1 which was largely dependent on tumor size. Of those patients who trialed preoperative cabergoline (n=91, 71.7%), a total of 61 (67%) patients experienced normalization of prolactin levels immediately following surgery. Normalization of prolactin levels were seen in 98%, 77%, 47%, 20%, and 25% of patients for those tumors measuring 0-1 cm, 1-2 cm, 2-3 cm, 3-4 cm, and 4-5 cm, respectively. Recurrence of hyperprolactinemia without a dopamine agonist occurred in 13.6%, 24.1%, 35.0%, 50%, 0% (only 2 patients) for tumors measuring 0-1 cm, 1-2 cm, 2-3 cm, 3-4 cm, and 4-5 cm, respectively. Surgical associated morbidity included postoperative CSF leak among 5 patients (4%).
Conclusion: Surgery via the endoscopic endonasal transsphenoidal approach should be considered as an upfront therapy in select cases if performed by an experienced multidisciplinary skull base team. While there exists tremendous debate as to factors associated with surgical candidacy, in experienced centers, surgery can outperform or equal the efficacy of cabergoline in lesions up to 3cm.
Fig. 1: Biochemical remission at POD1 (left; n= 127) and at ≥ 1-year follow-up (right; n=81) for prolactinomas of varying pre-operative size and prolactin expression (bottom row; x- and y-axis, respectively). Three patients with biochemical remission on follow-up had initiated Cabergoline post-operatively, for the first time (yellow dots).
POD1: Post-Operative Day 1