title: Transsphenoidal surgery for microprolactinomas in women: results and prognosis.
abstract: BACKGROUND
  Long-term dopamine agonist (DA) therapy is recommended as a first-line approach for the management of microprolactinomas. However, DA therapy may be poorly tolerated by some patients, and therefore some patients continue to prefer surgery over DA therapy.
  
  
  OBJECTIVE
  The aim of our study was to evaluate factors associated with favorable outcomes after surgical treatment of microprolactinomas in women.
  
  
  METHODS
  Thirty-two women (mean age 31.0 ± 8.2 years) with confirmed microprolactinomas who were operated using transsphenoidal approach were included to the study. Twenty-two (61 %) women had previous DA therapy and ten (39 %) women preferred surgery as a first treatment. Mean follow-up was 4.2 ± 2.7 years. Surgery was considered to be effective and remission achieved if serum prolactin was normal without DA therapy and there were no signs of tumor re-growth on neuroimaging.
  
  
  RESULTS
  Nine (47.4 %) patients in whom remission was achieved did not receive preoperative DA therapy when compared to one (7.7 %) patient in whom remission was not achieved (p = 0.02). Remission after operation was achieved in nine out of ten (90 %) patients who did not receive DA therapy compared to ten out of 22 patients (45.5 %) who were treated with DAs (p = 0.01). The independent factor associated with good outcome following surgical treatment was no preoperative DA therapy (RR = 14.57 (1.43-148.1), p = 0.02). Surgical complications were permanent diabetes insipidus in two patients (6.3 %) and transient DI in five (15.6 %) patients.
  
  
  CONCLUSIONS
  The main factor associated with favorable microprolactinoma surgery outcome in women was the absence of preoperative DA therapy.
authors.affiliation: Laboratory of Neurooncology and Genetics, Institute of Neurosciences, Eiveniu g. 4, Kaunas, Lithuania. arimantas.tamasauskas@lsmuni.lt
authors.forename: Arimantas
authors.initials: A
authors.lastname: Tamasauskas
authors.forename: Kestutis
authors.initials: K
authors.lastname: Sinkunas
authors.forename: Adomas
authors.initials: A
authors.lastname: Bunevicius
authors.forename: Andrius
authors.initials: A
authors.lastname: Radziunas
authors.forename: Daina
authors.initials: D
authors.lastname: Skiriute
authors.forename: Vytenis P
authors.initials: VP
authors.lastname: Deltuva
mesh_terms: D000328:Adult; D018491:Dopamine Agonists / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D011388:Prolactin / Q000097:blood; D015175:Prolactinoma / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D018491:Dopamine Agonists; D011388:Prolactin