• J. Korean Med. Sci. · Apr 2021

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

    • Kawngwoo Park, Kwang Hyon Park, Hye Ran Park, Jae Meen Lee, Yong Hwy Kim, Dong Young Kim, Tae Bin Won, Sung Hye Kong, Jung Hee Kim, Chan Soo Shin, and Sun Ha Paek.
    • Department of Neurosurgery, Gachon University Gil Medical Center, Incheon, Korea.
    • J. Korean Med. Sci. 2021 Apr 19; 36 (15): e97.

    BackgroundAlthough 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.MethodsIn 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).ResultsThe 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.ConclusionTSA can be considered a safe and potentially curative treatment for selective microprolactinomas as an alternative to treatment with a long-term DA.© 2021 The Korean Academy of Medical Sciences.

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