In prolactin secreting pituitary adenomas, surgery markedly reduced with the efficacy of dopamine agonists in controlling prolactin hypersecretion and reducing tumor mass. Some surgeons, instead of necessity of almost life-long medical therapy, prefer and recommend surgery as a first line treatment with potentially high success rates especially in microprolactinomas. We evaluated our patients with prolactinoma operated mostly without any evidence of resistance or intolerance to dopamine agonist therapy.
Retrospective analyses of 64 patients with prolactinoma treated with surgery were included in the study. Many of the patients were operated with the aim to diminish constraint effect of the adenoma on visual area or pituitary function without any evidence of resistance or intolerance to the dopamine agonists. Fifty-seven (89%) patients had got macroadenoma while only 7 (11%) had got microadenoma. Magnetic resonance imaging of sella turcica obtained 36 months after operation revealed apparent remnant in 29 patients (45%). Biochemical cure was obtained in only 18 (28%) patients. Cure probability was calculated 57% (4/7) in microadenomas and 25% (14/57) in macroadenomas. Success rate for visual field deficit was 38% (10/28) and 14 patients (50%) inform only slight improvement. Four (12%) patient did not inform any improvement in their visual acuity. In 46 patients without cure after surgery, long term treatment with dopamine agonists attained apparent improvement of hyperprolactinemia and related symptoms in 45 of 46 patients (98%).
We conclude that surgery for macroadenomas do not achieve good success rate even for cure of prolactinoma but also for improvement of visual field deficit or hypopituitarism. Medical therapy should be the only first line treatment in all patients with prolactinoma unless in patients with urgent indication of surgical intervention.
30 Apr - 04 May 2011
European Society of Endocrinology