Prolactinomas: Prognostic Factors of Hormonal Remission and Disease Recurrence After Endoscopic Transsphenoidal Surgery

Prolactinomas,are treated medically or surgically.While dopamine agonists(DAs) are first-line therapy,the endoscopic endonasal approach(EEA) offers lowmorbidity and shorter hospital stays.This study examines EEA outcomes andfactors affecting remission and recurrence.MethodsMethodsA retrospective analysis was conducted on 201 consecutive patientsdiagnosed with prolactinomas who underwent EEA between January 2014 andJanuary 2024.All surgeries were performed at a single tertiary center,with patients followed for a mean duration of 44.19 ± 25.81 months(range: 18–121months).ResultsThe mean tumor volume was 24.61± 13.97 (5-66)mm and gross total resection(GTR) was noted in 140/201(69.7%)patients. 41/201(20.4%)of patients hadoperation history.A history of preoperative medical treatment was present in162/201(80.6%) patients. Early disease remission was correlated with femalegender (p=0.039) and absence of preoperative prolactin level>200 μg/L(p<0.001) according to multivariate analysis.Persistent disease was reported in89/201(44.3%) of patients, with 44.9% of them achieved remission at lastfollow-up with DA therapy alone.Repeat EEA was utilized in 10 patients, with70% achieving remission.Last follow-up remission was achieved in 112/201(55.7%) patients, with symptomatic improvement in 136/201 (67.7%).Factorspredicting last follow-up remission were female sex (p=0.011),absence of preoperative prolactin level>200 μg/L (p=0.022),and absence of firm-fibrotictumor nature (p<0.001) according to logistic regression analysis.Recurrenceoccurred in 44/201(21.9%) patients,with early recurrence in 20/44 cases andlate recurrence in 24/44 cases.Disease control was achieved with medicaltreatment after recurrence in 6/44 patients,while 20/44 patients did not benefitfrom medical therapy.ConclusionsEEA effectively controls prolactinomas by significantly reducing tumor volume.Identifying predictors of remission and recurrence is crucial for EEA’s role as analternative to medical management.