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Introduction : Prolactinomas are primarily treated with medical therapy. Given the efficacy of dopamine agonists (DAs), surgery has remained a second-line treatment option. Objective : to evaluate the indications, efficacy, and safety of both treatments in MP. Methods : We performed a retrospective analysis of all patients with MP treated at our institution from January 2007 to October 2018. We divided the patients into two groups: medical treatment with DA (Group 1) and surgery (Group 2). Results: Prolactinomas (n: 69) constituted 36.9% of the total population of pituitary adenomas of our hospital (n: 187). 81.2% were MP (n: 56), from which 53.6% were included in Group 1 (n: 30) and 46.4% in Group 2 (n: 26). The mean follow-up was 50.9 months. There were no significant differences in age, sex, initial prolactin (PRL) value and tumor size between groups. Within the surgical indications (n:24), 29.2% were operated due to uncertain diagnosis, 29.2% due to visual impairment, 25% due to failure of medical treatment, 4.2% due to DAs intolerance, 4.2% due to apoplexy, 4.2% due to fistula and 4.2% due to the patient choice. 68.2% of the patients received DA therapy prior to surgery (15/22). There were no significant differences in the complication rate between both groups (66.7% Group 2 vs 40.7% Group 1, p: 0.09), although panhypopituitarism was significantly more frequent in Group 2 (54.2% vs 25.9%, p: 0.049, RR: 2.089). There were no significant differences between age, sex, tumor reduction and evolution between both groups. Invasive tumors (Knosp 4) were more frequent in Group 2 (59% vs 32%, p: 0.0149). Patients with biochemical persistence were younger (m: 25.5 ± 11 vs 40.7 ± 13.3 years, p: 0.01) and had a higher Knosp value (median 4 vs 3, p: 0.04) than patients in remission. Patients with postsurgical complications had a higher Knosp value in the initial image (median 4 vs 3, p: 0.04). Only 17.4% of the patients in group 2 were able to remain off DA after surgery. Conclusion: The percentage of patients with MP in our series is greater than that reported in the literature. As a neurosurgical reference center, we generally receive patients with more complex tumors. Although we had a high percentage of surgeries in patients with MP, this was due to the tumor characteristics or to an inadequate response to the DAs in our series. The patients who required surgical treatment had more invasive tumors, and coincidentally, these had the greatest number of complications. However, the only statistically significant complication between the two groups was panhypopituitarism. Despite the fact that only a small group of the operated patients could remain without medical treatment and that there were no differences in the evolution, surgery remains an alternative effective treatment option particularly for those patients with intolerance to DAs or highly invasive or resistant tumors.

Introduction Giant adenomas (GA) represent 5% of the entire pituitary adenomas (PA) in the reported surgical series. Despite their benign behavior, GA can cause important symptoms and signs due to the possible hyper-secretion of one or more pituitary hormones, involvement of surrounding structures or compression of the pituitary gland. Surgical resection remains the gold standard to decompress the optic chiasm, reduce tumor volume and preserve hormonal function Objective To evaluate the characteristics of GA attended in our hospital in the last 11 years. Materials and methods We conducted a retrospective analysis on clinical records of our patients with PA from January 2007 to April 2018. Results We included 25 patients with GA, who represented 14.4% of our total PA population (n: 173). The mean age was 39.2 ± 17.8 years (r: 15-79). GA were significantly more frequent in men than in women (64% vs. 35.1% respectively, p: 0.004, RR: 1.82). The main initial symptoms were visual defects in 88% of the AG. Invasive tumors (Knosp 4) were significantly more frequent in GA than in PA (81.8% vs. 21.9% respectively, p<0.0001, RR: 3.72). According to the clinical diagnosis, 48% of the GAs were non-functioning adenomas (NFA), while this diagnosis represented only 25.7% of the total PA (p: 0.01, RR: 1.86). Regarding these patients with NFA, both groups had similar age, but GA were more invasive (knosp 4) than PA (RR 2.4; p: 0, 05).80% (20 patients) of GA underwent surgical treatment (48% with transsphenoidal approach), while the rest (5 patients) received cabergoline since they were prolactinomas. The pathology data from 17 out of 20 patients was available: 35.3% gonadotroph, 23.5% lactotroph, 23.5% somatotroph, 5.9% mamosomatotroph, 5.9% corticotroph and 5.9% inmunohistochemically (IHQ) negative.Six patients underwent a 2 nd surgery, and 3 of them required radiotherapy. Out of the 20 patients operated, 3 died. According to the progression-free survival, calculated by Kaplan-Meier curves, 60% of both GA and PA would be stable after 10 years. The mean remission time of GA (n: 18) was 7.2 years (r:1 month-9,5ys). The mean follow-up period was 3.1 ys (r: 1 month-9,5ys). Conclusion The frequency of GA (14.4%) is slightly higher than the reported in literature. GA were predominant in males, similarly to the reported data. As expected, the visual field defect was the main initial presentation. The GAs were more invasive according to the Knosp classification. Clinically, NFA were the most frequent, similar to that reported in other studies, and the great majority resulted LH and FSH + in IHQ. In spite of the great diameters that the GA can reach, their behavior does not seem to differ from the rest of the PA in terms of their slow growth capacity and evolution. In our experience, these tumors treated in a high complexity center have a progression-free survival similar to that of PA....