Pituitary surgery for small prolactinomas as an alternative to treatment with dopamine agonists.

Abstract

Despite the fact that consensus guidelines recommend long-term dopamine agonist (DA) therapy as a first-line approach to the treatment of small prolactinoma, some patients continue to prefer a primary surgical approach. Concerns over potential adverse effects of long-term medical therapy and/or the desire to become pregnant and avoid long-term medication are often mentioned as reasons to pursue surgical removal. In this retrospective study, 34 consecutive patients (30 female, 4 male) preferably underwent primary pituitary surgery without prior DA treatment for small prolactinomas (microprolactinoma 1-10 mm, macroprolactinoma 11-20 mm) at the Department of Neurosurgery, University of Bern, Switzerland. At the time of diagnosis, 31 of 34 patients (91%) presented with symptoms. Patients with microprolactinomas had significantly lower preoperative prolactin (PRL) levels compared to patients with macroprolactinomas (median 143 μg/l vs. 340 μg/l). Ninety percent of symptomatic patients experienced significant improvement of their signs and symptoms upon surgery. The postoperative PRL levels (median 3.45 μg/l) returned to normal in 94% of patients with small prolactinomas. There was no mortality and no major morbidities. One patient suffered from hypogonadotropic hypogonadism after surgery despite postoperative normal PRL levels. Long-term remission was achieved in 22 of 24 patients (91%) with microprolactinomas, and in 8 of 10 patients (80%) with macroprolactinomas after a median follow-up period of 33.5 months. Patients with small prolactinomas can safely consider pituitary surgery in a specialized centre with good chance of long-term remission as an alternative to long-term DA therapy.

• Authors: Muriel Babey, Rahel Sahli, Istvan Vajtai, Robert H Andres, Rolf W Seiler
• Journal: Pituitary (Pituitary) Vol. 14 Issue 3 Pg. 222-30 (Sep 2011) ISSN: 1573-7403 [Electronic] United States
• PMID: 21170594 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Dopamine Agonists
• Prolactin

Topics

• Adolescent
• Adult
• Dopamine Agonists (therapeutic use)
• Female
• Humans
• Hyperprolactinemia (blood, drug therapy, surgery)
• Male
• Middle Aged
• Prolactin (blood)
• Prolactinoma (blood, drug therapy, surgery)
• Retrospective Studies
• Treatment Outcome
• Young Adult