Adverse Mood Symptoms, Health-Related Quality of Life, and Disease Burden in Patients with Prolactinoma after Neurosurgical Counseling and Pharmacological Treatment

Patients with prolactinoma are often initially treated with dopamine agonists (DAs). Although in many cases effective, DAs can cause severe (psychological) side effects and sometimes require lifelong intake. Neurosurgical counseling offers an alternative treatment option. The current study investigated whether neurosurgical counseling leads to better outcomes than DA treatment regarding adverse mood symptoms, health-related quality of life (HRQoL), and disease burden in patients with prolactinoma. A preliminary analysis of the Prolactinoma Clinical Trial-study was conducted. Patients were included in a randomized controlled trial or the observational arm, receiving either neurosurgical counseling or DA treatment. Adverse mood symptoms (Hospital Anxiety and Depression Scale; HADS), HRQoL (Short-Form Health Survey; SF-36), and disease burden (Leiden Bothers and Needs Questionnaire; LBNQ) were measured at baseline and 12 months follow-up. Demographic and clinical variables were derived...Show morePatients with prolactinoma are often initially treated with dopamine agonists (DAs). Although in many cases effective, DAs can cause severe (psychological) side effects and sometimes require lifelong intake. Neurosurgical counseling offers an alternative treatment option. The current study investigated whether neurosurgical counseling leads to better outcomes than DA treatment regarding adverse mood symptoms, health-related quality of life (HRQoL), and disease burden in patients with prolactinoma. A preliminary analysis of the Prolactinoma Clinical Trial-study was conducted. Patients were included in a randomized controlled trial or the observational arm, receiving either neurosurgical counseling or DA treatment. Adverse mood symptoms (Hospital Anxiety and Depression Scale; HADS), HRQoL (Short-Form Health Survey; SF-36), and disease burden (Leiden Bothers and Needs Questionnaire; LBNQ) were measured at baseline and 12 months follow-up. Demographic and clinical variables were derived from electronic patient files. To investigate the effects of time, group, and time*group interaction, multivariate linear mixed models were performed on outcomes of the HADS, SF-36, and LBNQ, controlling for age, sex, and prolactin levels at baseline. Data were available for 71, 61, and 69 patients in the analysis on the HADS, SF-36, and LBNQ, respectively. A larger decline in anxiety symptoms was found in the group of neurosurgical counseling (time*group; B = -3.66 (95% CI [-5.85 – -1.47]), p = .001) compared to the DA group. Prolactin levels at baseline were predictive of more adverse mood symptoms, lower mental well-being, and more perceived bothers at 12 months follow-up (all p < .004). Neurosurgical counseling showed comparable effects to DA treatment in terms of HRQoL and disease burden but was superior at relieving anxiety symptoms. Furthermore, prolactin levels emerged as a more potent predictor of these outcomes than the choice of treatment. These findings may optimize treatment for patients with prolactinoma, addressing their mood, emotional well-being, and HRQoL.Show less

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Adverse Mood Symptoms, Health-Related Quality of Life, and Disease Burden in Patients with Prolactinoma after Neurosurgical Counseling and Pharmacological Treatment