Recovery of hypopituitarism in macroprolactinomas: a comparison of medical vs. surgical treatment. Results from a European multicenter retrospective study

Mario Detomas; Barbara Altieri; Isabella Nasi-Kordhishti; Alice Ryba; Linus Haberbosch; Francesco Chierigo; Timo Deutschbein; Martin Fassnacht; Pietro Mortini; Joerg Flitsch; Jurgen Honegger; Marco Losa

doi:10.1530/endoabs.109.OP1.3

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Endocrine Abstracts (2025) 109 OP1.3 | DOI: 10.1530/endoabs.109.OP1.3

SFEBES2025 Poster Oral Presentations Neuroendocrinology and Pituitary (4 abstracts)

Recovery of hypopituitarism in macroprolactinomas: a comparison of medical vs. surgical treatment. Results from a European multicenter retrospective study

Mario Detomas ^1,2 , Barbara Altieri ¹ , Isabella Nasi-Kordhishti ³ , Alice Ryba ⁴ , Linus Haberbosch ⁵ , Francesco Chierigo ⁶ , Timo Deutschbein ¹ , Martin Fassnacht ¹ , Pietro Mortini ⁷ , Joerg Flitsch ⁴ , Jürgen Honegger ³ & Marco Losa ⁷

Author affiliations

¹Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany; ²Department of Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine, Queen Mary University of London, London, United Kingdom; ³Department of Neurosurgery and Neurotechnology, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany; ⁴Department of Neurosurgery, Medical Center Hamburg-Eppendorf, Hamburg, Germany; ⁵Department of Endocrinology and Metabolism; European Reference Network on Rare Endocrine Diseases (ENDO-ERN), Charité Universitätsmedizin, Berlin, Germany; ⁶Department of Surgical and Diagnostic Integrated Sciences, University of Genova, Genova, Italy; ⁷Department of Neurosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy

Context: Macroprolactinomas not only cause hypogonadism, but also other pituitary dysfunctions, like deficiency of adrenocorticotrophic hormone (ACTH) and thyroid-stimulating hormone (TSH). While dopamine agonist treatment shows varying recovery rates of these insufficiencies, surgical outcomes are less studied, and a direct comparison between treatments is lacking.

Objective: To evaluate recovery of pituitary dysfunction in medically vs surgically treated patients with macroprolactinoma.

Design: Retrospective multicenter study including 104 patients with macroprolactinoma (44 surgically vs 60 medically treated) with at least two hormonal deficiencies before treatment.

Results: Before surgery, all patients presented with hypogonadotropic hypogonadism, 25 (57%) with ACTH-deficiency, and with 32 (73%) TSH-deficiency. 10 months post-surgery, prolactin normalized in 25 (57%) patients, while 19(43%), 15 (60%) and 10(31%) recovered from hypogonadism, ACTH-deficiency, and TSH-deficiency, respectively. Before medical therapy, hypogonadism was observed in all patients, ACTH-deficiency in 31 (52%), and TSH-deficiency in 50 (83%). After 12 months under dopamine agonists, prolactin levels normalized in 36 (60%) patients, 25(42%) recovered from hypogonadism, 17 (55%) from ACTH-deficiency, and 14(28%) from TSH-deficiency. No significant difference in recovery rates between surgical and medical treatment for hypogonadism (OR 1.633, p=0.338), ACTH-deficiency (OR 0.462, p=0.319), or TSH-deficiency (OR 0.584, p=0.339) was observed. Initial tumor size was a significant negative predictor of recovery for all hormone deficiencies (always p<0.05), while prolactin normalization was a predictor of recovery of hypogonadism (p<0.001).

Conclusion: Both surgical and medical treatment allow for hormonal recovery in patients with macroprolactinoma, with no significant advantage for either approach. Initial tumor size and prolactin-normalization are predictors of recovery outcomes.