Abstract
Objectives Initial therapy for the management of prolactinomas has long been maintained to be
medical, consisting of a dopamine agonist. These therapies may have troublesome side
effects, and some prolactinomas are resistant to medical therapy regarding lowering
prolactin levels or shrinking the tumor. These issues have revived interest in surgery
for prolactin-secreting adenomas as an early therapeutic option. We report our analysis
of surgery for prolactin microadenomas in women, using the transsphenoidal endoscopic
approach.
Design We reviewed a contemporary series of 33 women (mean age = 31.8 years) with microprolactinomas
who underwent early surgical intervention, which was a three-dimensional transnasal
transsphenoidal endoscopic operation.
Setting The study was conducted at a tertiary academic referral center for pituitary tumors.
Main Outcome Measures Preoperative and postoperative prolactin.
Results Overall, 28 patients had received preoperative dopamine agonists, 24 of these experienced
a variety of drug-related side effects, and 4 had tumors that were resistant to lowering
prolactin or tumor shrinkage. Preoperative prolactin levels averaged 90.3 ng/mL (range = 30.7–175.8
ng/mL). We observed a 94% normalization rate in postoperative prolactin (mean = 10.08
ng/mL, range = 0.3–63.1 ng/mL). During the follow-up (mean = 33.9 months), five patients
had elevated prolactin; four required reinitiation of medical therapy, two had surgical
reexploration, and none received radiation therapy. Complications included syndrome
of inappropriate antidiuretic hormone secretion (n = 3), transient diabetes insipidus (n = 1), postoperative epistaxis (n = 1), and fat graft site infection (n = 1).
Conclusion This review supports the consideration of transsphenoidal surgery as an early intervention
for some women with prolactin-secreting microadenoma. Indications include significant
side effects of medical therapy and tumors that do not respond to standard medical
management.
Keywords
prolactinoma - pituitary tumor - dopamine agonist side effects - endoscopic transsphenoidal
surgery
