Surgical Treatment of Prolactinomas: Potential Role as a First-Line Treatment Modality
- Author:
Eui Hyun KIM
1
;
Junhyung KIM
;
Cheol Ryong KU
;
Eun Jig LEE
;
Sun Ho KIM
Author Information
- Publication Type:Original Article
- From:Yonsei Medical Journal 2023;64(8):489-496
- CountryRepublic of Korea
- Language:English
-
Abstract:
Purpose:Treatment with dopamine agonists (DAs) has been the first-line standard treatment for prolactinoma, and surgery has been reserved for drug intolerance and resistance for several decades. We evaluated whether surgery plays a primary role in prolactinoma management.
Materials and Methods:We conducted a retrospective study of 210 prolactinoma patients who had received surgical treatment at our institution. We analyzed the treatment outcomes according to tumor extent, sex, and preoperative DA medication.
Results:Overall hormonal remission was achieved in 164 patients (78.1%), and complete removal was achieved in 194 patients (92.4%). When the tumors were completely removed, the remission rate increased to 84.5%. Anterior pituitary function was normalized or improved in 94.6% of patients, whereas only 4.1% of patients showed worsening of hormone control. Hormonal remission was higher in patients who had not received DA preoperatively than in those who had received preoperative DA treatment. Smaller tumor size (<1 cm), no invasion into the cavernous sinus, and female sex were predictors of good surgical outcomes.
Conclusion:Although DAs remain the first-line standard treatment for prolactinomas, surgery can be an excellent option and should be considered as an alternative primary treatment modality when patients are predicted to achieve a good surgical outcome.
