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Pituitary surgery for small prolactinomas as an alternative to treatment with dopamine agonists Babey M; Sahli R; Vajtai I; Andres RH; Seiler RWPituitary 2011[Sep]; 14 (3): 222-30Despite 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 mug/l vs. 340 mug/l). Ninety percent of symptomatic patients experienced significant improvement of their signs and symptoms upon surgery. The postoperative PRL levels (median 3.45 mug/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.|Adolescent[MESH]|Adult[MESH]|Dopamine Agonists/*therapeutic use[MESH]|Female[MESH]|Humans[MESH]|Hyperprolactinemia/blood/drug therapy/surgery[MESH]|Male[MESH]|Middle Aged[MESH]|Prolactin/blood[MESH]|Prolactinoma/blood/*drug therapy/*surgery[MESH]|Retrospective Studies[MESH]|Treatment Outcome[MESH]|Young Adult[MESH] |
