Background: Medical therapy with dopamine agonists (DA) is the primary treatment in most patients with prolactinomas. Classical surgical indications are mainly intolerance of DA therapy or non-responders. Focusing on a possible shift of recent indications towards a surgical approach, we retrospectively analyzed the long-term results of surgical treatment and compared them to the medically treated female patients with prolactinomas.
Patients and methods: Between 1977 and 2007, the chards of 105 female patients with prolactinoma were reviewed. Clinical, biochemical characteristics and tumour size were assessed at baseline and at last follow-up in the patients who underwent transsphenoidal surgery (S; n=71) and in the medically treated cohort (M; n=34). Within the S group a subgroup with intrasellar microadenoma (IS; n=41) were analysed separately.
Results: The mean age at diagnosis, clinical presentation, prolactin levels and the tumour size was similar in the S and the M group at baseline (age: S: 33.3 (9.9) years, mean (S.D.) versus M: 35.4 (5.0); Prolactin: S: 182.2 (89.7249), μg/l, median (IQR); M: 110.8 (85.5679.5); Tumour size: macro-/meso-/microadenoma: S: 17%; 25%; 58% versus M: 23%;9%; 68%; NS). The mean follow-up was similar in both groups (S: 121 (99) months, mean (S.D.) versus M: 112 (93); NS).
At last follow-up, galactorrhea was reported in 9% of the M and in 3% of the S patients (P=0.17). Persistent amenorrhoea was documented in 6% and in 5% of the S and M cohort, respectively. Prolactin levels were controlled in 87% (S) vs 72% (M; P=0.07) requiring DA therapy in 66% (M) and in 32% (S) of the patients (P<0.001). Analysis of the surgical treated group with intrasellar micoradenoma (IS) revealed a control of hyperprolactinaemia in 91% of the patients requiring DA therapy in 26%. Patients with microadenoma medically treated had a control of hyperprolactinaemia in 84% with a persistent need for DA therapy in 52%. Transient complications of transsphenoidal surgery included diabetes insipidus (23%) and liquor fistula (4.2%). Persisting complications consisted of an additional pituitary axis insufficiency in 4.2%, similar to the findings in the M group. There was no mortality associated with the surgical intervention. Transient side effects of DA therapy (nausea, orthostatic problems) were present in 36% of the patients.
Conclusion: (1) Transsphenoidal surgery for prolactinoma in female patients has no mortality in this cohort (2) Transitory side effects of treatment strategy occur in the S and M cohort in a substantial number of cases (3) The long-term control of hyperprolactinaemia in the S and M is similar (4) The present data justify at least the discussion about a neurosurgical approach in selected patients.