title: Pituitary surgery for small prolactinomas as an alternative to treatment with dopamine agonists.
abstract: Despite 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 μg/l vs. 340 μg/l). Ninety percent of symptomatic patients experienced significant improvement of their signs and symptoms upon surgery. The postoperative PRL levels (median 3.45 μg/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.
authors.affiliation: Department of Neurosurgery, University of Berne, Inselspital, 3010, Berne, Switzerland. muriel.babey@ucsf.edu
authors.forename: Muriel
authors.initials: M
authors.lastname: Babey
authors.forename: Rahel
authors.initials: R
authors.lastname: Sahli
authors.forename: Istvan
authors.initials: I
authors.lastname: Vajtai
authors.forename: Robert H
authors.initials: RH
authors.lastname: Andres
authors.forename: Rolf W
authors.initials: RW
authors.lastname: Seiler
mesh_terms: D000293:Adolescent; D000328:Adult; D018491:Dopamine Agonists / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006966:Hyperprolactinemia / Q000097:blood / Q000188:drug therapy / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011388:Prolactin / Q000097:blood; D015175:Prolactinoma / Q000097:blood / Q000188:drug therapy* / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018491:Dopamine Agonists; D011388:Prolactin