Abstract
Background Current guidelines recommend dopamine agonists (DA) as the
primary therapeutic approach for prolactinomas; however, emerging evidence
suggests that surgical intervention can also yield favorable outcomes.
Objective To comprehensively evaluate prolactinoma patients undergoing
surgical and medical treatments at our pituitary center.
Methods Retrospective review of mMedical records from prolactinoma
patients treated between 2015 and 2022 was performedwere retrospectively
reviewed. The study focused on treatment outcomes and remission rates while
investigating factors influencing the success of both treatment modalities in
achieving remission.
Results A total of 301 prolactinoma patients were included, of whom 199
were women. Among them, 235 were managed medically, while 66 underwent surgical
intervention. The overall remission rates of patients treated with medical and
surgery were similar at the final examination (Respectively respectively 82.9%
and 81.8%, p=0.114). Factors associated with remission in both treatment
modalities included female sex, low initial prolactin levels, small adenoma
size, and absence of cavernous invasion. Compared to DA treatment, Ssurgical
treatment demonstrated a higher rate of drug-free remission compared to DA
treatment for microadenomas, and macroadenomas without cavernous invasion. In
cases with cavernous invasion, standalone surgical treatment yielded a low rate
of drug-free remission (7.7%); however, when combined with DA therapy
post-surgery, remission rates increased to 66.7%.
Conclusion Medical treatment with DAs remains the preferred option for
macroadenomas with cavernous sinus invasion, and giant adenomas, with surgery
reserved for selected cases to address complications. Conversely, surgery
emerges as the most effective modality for achieving remission in patients with
microadenomas, and macroadenomas confined to the sella. The recommendation of
DAs as first-line therapy for all patients has been withdrawn in the current
guidelines, and individual treatment approaches based on tumor characteristics
are emphasized. Our results support this approach.
Keywords
endoscopic transsphenoidal surgery - dopamine agonists - prolactinoma - remission - treatment
