Transsphenoidal surgery for microprolactinomas in women: results and prognosis

Arimantas Tamasauskas, Kestutis Sinkunas, Adomas Bunevicius, Andrius Radziunas, Daina Skiriute, Vytenis P Deltuva
Acta Neurochirurgica 2012, 154 (10): 1889-93

BACKGROUND: Long-term dopamine agonist (DA) therapy is recommended as a first-line approach for the management of microprolactinomas. However, DA therapy may be poorly tolerated by some patients, and therefore some patients continue to prefer surgery over DA therapy.

AIM: The aim of our study was to evaluate factors associated with favorable outcomes after surgical treatment of microprolactinomas in women.

METHODS: Thirty-two women (mean age 31.0 ± 8.2 years) with confirmed microprolactinomas who were operated using transsphenoidal approach were included to the study. Twenty-two (61 %) women had previous DA therapy and ten (39 %) women preferred surgery as a first treatment. Mean follow-up was 4.2 ± 2.7 years. Surgery was considered to be effective and remission achieved if serum prolactin was normal without DA therapy and there were no signs of tumor re-growth on neuroimaging.

RESULTS: Nine (47.4 %) patients in whom remission was achieved did not receive preoperative DA therapy when compared to one (7.7 %) patient in whom remission was not achieved (p = 0.02). Remission after operation was achieved in nine out of ten (90 %) patients who did not receive DA therapy compared to ten out of 22 patients (45.5 %) who were treated with DAs (p = 0.01). The independent factor associated with good outcome following surgical treatment was no preoperative DA therapy (RR = 14.57 (1.43-148.1), p = 0.02). Surgical complications were permanent diabetes insipidus in two patients (6.3 %) and transient DI in five (15.6 %) patients.

CONCLUSIONS: The main factor associated with favorable microprolactinoma surgery outcome in women was the absence of preoperative DA therapy.

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