J Korean Med Sci.  2021 Apr;36(15):e97. 10.3346/jkms.2021.36.e97.

Long-term Outcome of Microscopic Transsphenoidal Surgery for Prolactinomas as an Alternative to Dopamine Agonists

• Park K
• Park KH
• Park HR
• Lee JM
• Kim YH
• Kim DY
• Won TB
• Kong SH
• Kim JH
• Shin CS
• Paek SH

• KMID: 2515039
• DOI: http://doi.org/10.3346/jkms.2021.36.e97

Abstract

Background
Although long-term dopamine agonist (DA) therapy is recommended as a first-line treatment for prolactinoma, some patients may prefer surgical treatment because of the potential adverse effects of long-term medication, or the desire to become pregnant. This study aimed to determine whether surgical treatment of prolactinomas could be an alternative to DA therapy.
Methods
In this retrospective study, 96 consecutive patients (74 female, 22 male) underwent primary pituitary surgery without long-term DA treatment for prolactinomas at a single institution from 1990 to 2010. All patients underwent primary surgical treatment in the microscopic transsphenoidal approach (TSA).
Results
The median age and median follow-up period were 31 (16–73) years and 139.1 (12.2–319.6) months, respectively. An initial overall remission was accomplished in 47.9% (46 of 96 patients, 33 macroadenomas, and 13 microadenomas) of patients. DA dose reduction was achieved in all patients after TSA. A better remission rate was independently predicted by lower diagnostic prolactin levels and by a greater extent of surgical resection. Overall remission at the last follow-up was 33.3%, and the overall recurrence rate was 30.4%. The permanent complication rate was 3.1%, and there was no mortality.
Conclusion
TSA can be considered a safe and potentially curative treatment for selective microprolactinomas as an alternative to treatment with a long-term DA.

Keyword

Pituitary Surgery; Prolactinoma; Dopamine Agonist; Microscopic Transsphenoidal Surgery

Figure

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  Fig. 1 Changes in PRL level after microscopic transsphenoidal approach.PRL = prolactin.

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  Fig. 2 Kaplan-Meier survival curves for complete remission after microscopic transsphenoidal approach.

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