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Pituitary surgery for small prolactinomas as an alternative to treatment with dopamine agonists

Babey, Muriel ; Sahli, Rahel ; Vajtai, Istvan ; Andres, Robert ; Seiler, Rolf

In: Pituitary, 2011, vol. 14, no. 3, p. 222-230

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    Titre
    • Pituitary surgery for small prolactinomas as an alternative to treatment with dopamine agonists
    Auteur
    • Babey, Muriel. Department of Neurosurgery, University of Berne, Inselspital, 3010, Berne, Switzerland
    • Sahli, Rahel. Division of Endocrinology, Diabetes and Clinical Nutrition, University of Berne, Inselspital, 3010, Berne, Switzerland
    • Vajtai, Istvan. Institute of Pathology, University of Berne, Inselspital, 3010, Berne, Switzerland
    • Andres, Robert. Department of Neurosurgery, University of Berne, Inselspital, 3010, Berne, Switzerland
    • Seiler, Rolf. Department of Neurosurgery, University of Berne, Inselspital, 3010, Berne, Switzerland
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • Pituitary, 2011, vol. 14, no. 3, p. 222-230. Springer US; http://www.springer-ny.com
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:318111
    Summary
    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 1-10mm, macroprolactinoma 11-20mm) 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 143μg/l vs. 340μg/l). Ninety percent of symptomatic patients experienced significant improvement of their signs and symptoms upon surgery. The postoperative PRL levels (median 3.45μg/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 33.5months. 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