Abstract
Introduction The first line treatment for prolactinomas is currently dopamine agonists (DAs).
Medical management is prolonged, associated with side effects, financial, and psychological
burdens. In dedicated centers, pituitary surgery is a low-risk alternative. We evaluated
outcome measures of medical and surgical treatment, to assess, if the role of surgery
is underestimated.
Methods We reviewed the charts of 4,660 pituitary patients, managed at the University of
Colorado, from 2004 to 2019. The final analysis included 154 patients with prolactinomas,
managed medically, and 120 patients, treated surgically. Primary outcome measures
were percentage of tumor volume reduction and prolactin level (ng/mL). Mann–Whitney
test was used for quantitative variables, contingency tables, and chi-square tests
for qualitative variables. Statistical significance was set at p < 0.05.
Results DAs alone were more frequently used for microprolactinomas and Knosp grade 0 adenomas.
Surgery was more often performed for macroprolactinomas, giant adenomas, tumors with
suprasellar extension, mixed consistency, and sellar floor erosion. Among macroprolactinomas,
mean tumor volume reduction after treatment with DAs alone, DAs and surgery, and surgery
alone was 53.8, 94.9, and 94.1%, respectively. Prolactin levels after treatment were
not significantly different. Continuous DA treatment was required in 94.3% patients
in the medical group versus 39.6% in the surgical group.
Conclusion Surgery for macroprolactinomas achieved greater tumor volume reduction and dose reduction
or discontinuation of DAs. Prolactin levels achieved did not differ significantly
between the groups. Over 60% of patients, undergoing surgery, were able to discontinue
DAs. The current treatment paradigm may underestimate the role of surgery in the management
of prolactinomas.
Keywords
pituitary adenoma - prolactinoma - pituitary surgery - dopamine agonists - outcomes
