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

Babey, Muriel; Sahli, Rahel; Vajtai, Istvan; Andres, Robert H; Seiler, Rolf W (2011). Pituitary surgery for small prolactinomas as an alternative to treatment with dopamine agonists. Pituitary, 14(3), pp. 222-30. Norwell, Mass.: Springer US; http://www.springer-ny.com 10.1007/s11102-010-0283-y

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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 1-10 mm, macroprolactinoma 11-20 mm) 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 143 μg/l vs. 340 μg/l). Ninety percent of symptomatic patients experienced significant improvement of their signs and symptoms upon surgery. The postoperative PRL levels (median 3.45 μg/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 33.5 months. 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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Endocrinology, Diabetology and Clinical Nutrition
04 Faculty of Medicine > Service Sector > Institute of Pathology
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery

UniBE Contributor:

Babey, Muriel; Sahli, Rahel Gerda; Vajtai, Istvan and Andres, Robert

ISSN:

1386-341X

Publisher:

Springer US; http://www.springer-ny.com

Language:

English

Submitter:

Factscience Import

Date Deposited:

04 Oct 2013 14:08

Last Modified:

26 Jun 2018 14:53

Publisher DOI:

10.1007/s11102-010-0283-y

PubMed ID:

21170594

Web of Science ID:

000293288900004

BORIS DOI:

10.7892/boris.704

URI:

https://boris.unibe.ch/id/eprint/704 (FactScience: 200420)

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