A comparative evaluation of effectiveness of medical and surgical therapy in patients with macroprolactinoma.
BACKGROUND
The surgical success rate in macroprolactinomas is quite low, while medical treatment is more effective in reducing PRL levels and tumour mass. In this study the effectiveness of surgical, medical and radiant approaches on clinical symptoms, PRL levels and tumour size were compared in a large series of patients with macroprolactinomas.


METHODS
One hundred and thirty-two patients (63 males and 69 females) were followed-up. Eighty-three patients were operated by trans-sphenoidal (TSS) approach: 18 underwent only TSS, 10 were operated and then irradiated; 30 patients underwent TSS and dopamine agonists, 25 were treated by TSS, radiotherapy and dopamine agonists. One hundred and four patients were treated by medical therapy: 49 patients were only administered dopamine agonists and 55 were given dopamine agonists after unsuccessful surgery and/or radiotherapy.


RESULTS
In 83 patients serum PRL levels decreased from 1873+/-319.9 ng/ml to 831.6+/-297.8 ng/ml after trans-sphenoidal surgery: a significant PRL reduction was obtained in 18 cases (22%) and a full PRL normalization was found in 15 patients (18%). The pituitary adenoma was completely removed in the 15 cases, in whom serum PRL normalized. Sexual function was restored in 57 percent; of women and in 29 percent; of men. In contrast, dopaminergic drugs normalized PRL levels (from 1590.5+/-232.7 to 19.2+/-4.8 ng/ml) in 93/104 patients (89 percent;). Sexual function was restored in 74 percent; of women and in 75 percent; of men. Radiotherapy, performed after unsuccessful TSS, was ineffective in normalizing PRL levels.


CONCLUSIONS
Medical therapy should be considered the first choice treatment in macroprolactinomas, while the surgical approach is recommended when neurological compressive symptoms are present and in patients resistant or intolerant to dopamine agonists. Radiotherapy may be indicated only in the patients in whom medical and surgical therapy have not been successful.
Acquati
S
S
Institute of Endocrine Sciences, University of Milan, Italy.
Pizzocaro
A
A
Tomei
G
G
Giovanelli
M
M
Libè
R
R
Faglia
G
G
Ambrosi
B
B
D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D018491:Dopamine Agonists / Q000008:administration & dosage* / Q000009:adverse effects; D007172:Erectile Dysfunction / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D005260:Female; D006261:Headache / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D010911:Pituitary Neoplasms / Q000188:drug therapy* / Q000473:pathology*; D011183:Postoperative Complications / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D011388:Prolactin / Q000097:blood / Q000187:drug effects; D015175:Prolactinoma / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D011878:Radiotherapy; D020127:Recovery of Function / Q000187:drug effects; D012189:Retrospective Studies; D016896:Treatment Outcome; D014786:Vision Disorders / Q000188:drug therapy / Q000209:etiology / Q000601:surgery
D000970:Antineoplastic Agents; D018491:Dopamine Agonists; D011388:Prolactin