title: THERAPY OF ENDOCRINE DISEASE: Surgery in microprolactinomas: effectiveness and risks based on contemporary literature.
abstract: Microprolactinomas are the most common pituitary adenomas. In symptomatic patients, dopamine agonists are the first-line treatment of choice; when cabergoline is used, biochemical control rates between 85 and 93% have been reported. Long-term treatment is needed in most of the cases with compliance, patient convenience, and potential adverse effects representing areas requiring attention. Based on the literature published in the past 15 years, transsphenoidal surgery can lead to normal prolactin in the postoperative period in usually 71-100% of the cases with very low postoperative complication rates. Surgical expertise is the major determinant of the outcomes, and it may be a cost-effective option in young patients with life expectancy greater than 10 years (provided it is performed by experienced surgeons at high volume centers with confirmed optimal outcomes). Larger series of patients with adequate follow-up could further validate the place of transsphenoidal surgery (particularly through the endoscopic approach for which long-term results are currently limited) in the management algorithm of patients with microprolactinoma.
authors.affiliation: Institute of Metabolism and Systems ResearchUniversity of Birmingham, Centre for EndocrinologyDiabetes and Metabolism, Birmingham Health Partners, Birmingham, UK.
authors.forename: Metaxia
authors.initials: M
authors.lastname: Tampourlou
authors.affiliation: Department of EndocrinologyCarol Davila University of Medicine and Pharmacy, Bucharest, Romania.
authors.forename: Raluca
authors.initials: R
authors.lastname: Trifanescu
authors.affiliation: Department of Neurosurgery.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Paluzzi
authors.affiliation: Department of OtorhinolaryngologyUniversity Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: Shahzada K
authors.initials: SK
authors.lastname: Ahmed
authors.affiliation: Institute of Metabolism and Systems ResearchUniversity of Birmingham, Centre for EndocrinologyDiabetes and Metabolism, Birmingham Health Partners, Birmingham, UK n.karavitaki@bham.ac.uk.
authors.forename: Niki
authors.initials: N
authors.lastname: Karavitaki
mesh_terms: D003131:Combined Modality Therapy; D018491:Dopamine Agonists / Q000627:therapeutic use*; D006801:Humans; D010911:Pituitary Neoplasms / Q000188:drug therapy / Q000601:surgery*; D015175:Prolactinoma / Q000188:drug therapy / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D018491:Dopamine Agonists