title: Microsurgical management of prolactinomas - clinical and hormonal outcome in a series of 172 cases.
abstract: OBJECTIVE
  To report hormonal outcome after surgery in a special subgroup of prolactinomas in whom medical therapy is not effective or not indicated.
  
  
  METHODS
  All patients who underwent surgery for prolactinomas, between December 2002 and December 2009, were analyzed retrospectively. The study group consisted of patients who were either intolerant or noncompliant to dopamine agonist (DA) therapy or those in whom medical treatment could not be given due to various reasons. The surgical results were assessed according to whether patients had microadenoma (<1 cm diameter), macroadenoma (>1 cm diameter), or giant prolactinoma (>4 cm diameter). Initial and final hormonal remission was defined as normalization of serum prolactin levels (<25 ng/ml) at 7 days after surgery and at last follow up, respectively.
  
  
  RESULTS
  Of the 172 patients, 133 (77%) were operated by primary transsphenoidal approach and 25 (14.5%) were operated transcranially and 14 patients required reoperation, either transsphenoidally (6 patients) or transcranially (8 patients). Overall, at last follow-up, hormonal remission could be achieved in 44% patients (83% microadenomas, 48% macroadenomas, and 16% of giant adenomas). There were three deaths (1.7%), 12 patients (7%) had single/multiple postoperative treatable complications. 59% of those patients, who did not achieve remission after surgery, finally attained normoprolactinemia with either DA therapy or radiotherapy, at last follow-up.
  
  
  CONCLUSIONS
  Medical treatment of prolactinomas with DA should be considered as treatment of choice for these tumors. However, there is a major subgroup of patients who respond better to surgery rather than protracted medical therapy.
authors: Department of Neurosurgery, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India. sumitaiims@yahoo.com
authors: Sumit
authors: S
authors: Sinha
authors: B S
authors: BS
authors: Sharma
authors: A K
authors: AK
authors: Mahapatra
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008866:Microsurgery / Q000379:methods*; D010911:Pituitary Neoplasms / Q000378:metabolism* / Q000601:surgery*; D011388:Prolactin / Q000378:metabolism*; D015175:Prolactinoma / Q000378:metabolism* / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D011388:Prolactin