{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T06:51:25Z","timestamp":1788504685265,"version":"build-2803163510"},"reference-count":34,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,3,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Socioeconomic status (SES) is known to affect presentations and outcomes in pituitary neuroendocrine tumor resections, but there is a paucity of literature examining its impact specifically on patients with prolactinomas, who may be treated medically or surgically. The authors sought to determine whether SES was associated with differences in treatment choice or outcomes for prolactinoma patients.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>The authors retrospectively reviewed patient records at a high-volume academic pituitary center for prolactinoma diagnoses. Patients were split into medically and surgically treated cohorts. Race, ethnicity, insurance status, primary care physician (PCP) status, and zip code\u2013based income data were collected and examined as socioeconomic covariates. Outcomes of interest included pretreatment likelihood of surgical cure, medical versus surgical treatment allocation, and posttreatment remission rates.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>The authors analyzed 568 prolactinoma patients (351 medically treated and 217 surgically treated). Patients receiving surgery were more likely to have Medicaid or private insurance (p &lt; 0.001) and have lower incomes (p &lt; 0.001) than medically treated patients. Lower-income surgical patients were more likely to require surgical intervention for an indication such as tumor decompression than higher-income patients (p = 0.023). Surgical patients with a PCP had a higher estimated likelihood of surgical cure (p = 0.008), while no SES-based differences in surgical remission likelihood existed in the medical cohort. After surgery, surgical patients who achieved remission had significantly higher income than those who did not (p &lt; 0.001). Other SES factors were not associated with surgical remission, and among medically treated patients, remission rates were not affected by any SES factor. Income was inversely related to prolactinoma size in both cohorts (surgical, p &lt; 0.001; medical, p = 0.005) but was associated more prominently in surgical patients (surgical, \u22120.65 mm per $10,000; medical, \u22120.37 mm per $10,000).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>While surgical prolactinoma patients were prone to income and PCP-related disparities, no SES disparities were found among medically treated patients. Income had a more pronounced association with tumor size in the surgical cohort and likely contributed to the increased need for surgical intervention seen in low-income surgical patients. Addressing socioeconomic healthcare disparities is needed among surgical prolactinoma patients to increase rates of early presentation and improve the outcomes of low-SES populations.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2023.6.jns23570","type":"journal-article","created":{"date-parts":[[2023,8,12]],"date-time":"2023-08-12T03:12:26Z","timestamp":1691809946000},"page":"712-723","source":"Crossref","is-referenced-by-count":6,"title":["Socioeconomic differences between medically and surgically treated prolactinomas: a retrospective review of 598 patients"],"prefix":"10.3171","volume":"140","author":[{"given":"Robert C.","family":"Osorio","sequence":"first","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander F.","family":"Haddad","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle M.","family":"Hart","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathaniel","family":"Goldrich","sequence":"additional","affiliation":[{"name":"School of Medicine, New York Medical College, Valhalla, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aarav","family":"Badani","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aymen S.","family":"Kabir","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan","family":"Juncker","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun Y.","family":"Oh","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis","family":"Carrete","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zain","family":"Peeran","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric J.","family":"Chalif","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison C.","family":"Zheng","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steve","family":"Braunstein","sequence":"additional","affiliation":[{"name":"Radiation Oncology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip V.","family":"Theodosopoulos","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivan H.","family":"El-Sayed","sequence":"additional","affiliation":[{"name":"Otolaryngology Head and Neck Surgery, University of California, San Francisco, California; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9","family":"Gurrola","sequence":"additional","affiliation":[{"name":"Otolaryngology Head and Neck Surgery, University of California, San Francisco, California; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandeep","family":"Kunwar","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lewis S.","family":"Blevins","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manish K.","family":"Aghi","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"3","key":"b1","series-title":"Cancer","first-page":"613","article-title":"The prevalence of pituitary adenomas: a systematic review","volume":"101","author":"Ezzat S","year":"2004","unstructured":"Ezzat S, Asa SL, Couldwell WT,  The prevalence of pituitary adenomas: a systematic review. Cancer. 2004;101(3):613\u2013619."},{"issue":"1","key":"b2","series-title":"Menoufia Med J","first-page":"87","article-title":"Surgical outcome of endoscopic versus microscopic trans-sphenoidal approach for pituitary adenomas","volume":"28","author":"Eltabl MA","year":"2015","unstructured":"Eltabl MA, Eladawy Y, Hanafy A, Gaber Saleh ED, Elnoomany HH. Surgical outcome of endoscopic versus microscopic trans-sphenoidal approach for pituitary adenomas. Menoufia Med J. 2015;28(1):87\u201392."},{"issue":"9","key":"b3","series-title":"J Endocrinol Invest","first-page":"703","article-title":"Recovery of visual and endocrine function following transsphenoidal surgery of large nonfunctioning pituitary adenomas","volume":"17","author":"Marazuela M","year":"1994","unstructured":"Marazuela M, Astigarraga B, Vicente A,  Recovery of visual and endocrine function following transsphenoidal surgery of large nonfunctioning pituitary adenomas. J Endocrinol Invest. 1994;17(9):703\u2013707."},{"issue":"2","key":"b4","series-title":"Best Pract Res Clin Endocrinol Metab","first-page":"101290","article-title":"The epidemiology, diagnosis and treatment of Prolactinomas: the old and the new","volume":"33","author":"Chanson P","year":"2019","unstructured":"Chanson P, Maiter D. The epidemiology, diagnosis and treatment of Prolactinomas: the old and the new. Best Pract Res Clin Endocrinol Metab. 2019;33(2):101290."},{"issue":"5","key":"b5","series-title":"Best Pract Res Clin Endocrinol Metab","first-page":"575","article-title":"Pituitary tumours: the prolactinoma","volume":"23","author":"Colao A","year":"2009","unstructured":"Colao A. Pituitary tumours: the prolactinoma. Best Pract Res Clin Endocrinol Metab. 2009;23(5):575\u2013596."},{"issue":"2","key":"b6","series-title":"Clin Endocrinol (Oxf)","first-page":"265","article-title":"Guidelines of the Pituitary Society for the diagnosis and management of prolactinomas","volume":"65","author":"Casanueva FF","year":"2006","unstructured":"Casanueva FF, Molitch ME, Schlechte JA,  Guidelines of the Pituitary Society for the diagnosis and management of prolactinomas. Clin Endocrinol (Oxf). 2006;65(2):265\u2013273."},{"issue":"5","key":"b7","series-title":"JAMA","first-page":"516","article-title":"Diagnosis and treatment of pituitary adenomas: a review","volume":"317","author":"Molitch ME","year":"2017","unstructured":"Molitch ME. Diagnosis and treatment of pituitary adenomas: a review. JAMA. 2017;317(5):516\u2013524."},{"issue":"2","key":"b8","series-title":"Pituitary","first-page":"141","article-title":"Hyperprolactinemia","volume":"11","author":"Chahal J","year":"2008","unstructured":"Chahal J, Schlechte J. Hyperprolactinemia. Pituitary. 2008;11(2):141\u2013146."},{"issue":"1","key":"b9","series-title":"Expert Rev Endocrinol Metab","first-page":"25","article-title":"Medical versus surgical treatment of prolactinomas: an analysis of treatment outcomes","volume":"13","author":"Rutkowski MJ","year":"2018","unstructured":"Rutkowski MJ, Aghi MK. Medical versus surgical treatment of prolactinomas: an analysis of treatment outcomes. Expert Rev Endocrinol Metab. 2018;13(1):25\u201333."},{"issue":"1","key":"b10","series-title":"Endocrine","first-page":"223","article-title":"10-year follow-up study comparing primary medical vs. surgical therapy in women with prolactinomas","volume":"55","author":"Andereggen L","year":"2017","unstructured":"Andereggen L, Frey J, Andres RH,  10-year follow-up study comparing primary medical vs. surgical therapy in women with prolactinomas. Endocrine. 2017;55(1):223\u2013230."},{"issue":"4","key":"b11","series-title":"Neurosurg Clin N Am","first-page":"669","article-title":"Medical versus surgical management of prolactinomas","volume":"23","author":"Oh MC","year":"2012","unstructured":"Oh MC, Kunwar S, Blevins L, Aghi MK. Medical versus surgical management of prolactinomas. Neurosurg Clin N Am. 2012;23(4):669\u2013678."},{"key":"b12","series-title":"Front Endocrinol (Lausanne)","first-page":"636","article-title":"The chance of permanent cure for micro- and macroprolactinomas, medication or surgery? A systematic review and meta-analysis","volume":"9","author":"Ma Q","year":"2018","unstructured":"Ma Q, Su J, Li Y,  The chance of permanent cure for micro- and macroprolactinomas, medication or surgery? A systematic review and meta-analysis. Front Endocrinol (Lausanne). 2018;9:636."},{"issue":"1","key":"b13","series-title":"Chin Neurosurg J","first-page":"9","article-title":"Are dopamine agonists still the first-choice treatment for prolactinoma in the era of endoscopy? A systematic review and meta-analysis","volume":"8","author":"Cai X","year":"2022","unstructured":"Cai X, Zhu J, Yang J, Tang C, Cong Z, Ma C. Are dopamine agonists still the first-choice treatment for prolactinoma in the era of endoscopy? A systematic review and meta-analysis. Chin Neurosurg J. 2022;8(1):9."},{"key":"b14","series-title":"Centers for Disease Control and Prevention","article-title":"Vital Signs: Health Insurance Coverage and Health Care Utilization\u2013United States, 2006\u20132009 and January\u2013March 2010","unstructured":"Vital Signs: Health Insurance Coverage and Health Care Utilization\u2013United States, 2006\u20132009 and January\u2013March 2010. Centers for Disease Control and Prevention. 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Laryngoscope. 2016;126(4):808\u2013814."},{"issue":"10","key":"b23","series-title":"Int Forum Allergy Rhinol","first-page":"1145","article-title":"The socioeconomic determinants for transsphenoidal pituitary surgery: a review of New York State from 1995 to 2015","volume":"8","author":"McKee S","year":"2018","unstructured":"McKee S, Yang A, Kidwai S, Govindaraj S, Shrivastava R, Iloreta A. The socioeconomic determinants for transsphenoidal pituitary surgery: a review of New York State from 1995 to 2015. Int Forum Allergy Rhinol. 2018;8(10):1145\u20131156."},{"issue":"5","key":"b24","series-title":"J Neurosurg","first-page":"1325","article-title":"Socioeconomic predictors of case presentations and outcomes in 225 nonfunctional pituitary adenoma resections","volume":"136","author":"Osorio RC","year":"2022","unstructured":"Osorio RC, Pereira MP, Joshi RS,  Socioeconomic predictors of case presentations and outcomes in 225 nonfunctional pituitary adenoma resections. 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