Management of selected patients with hyperprolactinaemia by partial hypophysectomy.

Abstract

Results are reported in 35 patients with prolactinomas who underwent pituitary surgery within the past five years. After surgery prolactin concentrations became normal in 26 patients and symptoms were alleviated, and nine normal pregnancies were achieved in seven women, including all those who had complained of infertility. Normal prolactin concentrations were restored in 16 of 17 patients with tumours 5-19 mm in diameter but in only six of 11 with tumours <4 mm and four of seven with tumours >20 mm. Normal prolactin concentrations were restored in all those with preoperative concentrations below 1000 mU/l but in none of those with concentrations above 10 000 mU/l. Although not all of the patients were followed up for five years, hyperprolactinaemia did not recur in any patient whose prolactin concentration had returned to normal six weeks after surgery. This included 16 patients with macroprolactinomas (>10 mm in diameter), who were followed up for from two to five years.These data contrast strikingly with those reported by others at similar stages of follow up and show clearly that partial hypophysectomy offers an acceptable alternative treatment for selected patients with prolactinomas. Initial results were encouraging, with claims of success rates of up to 86% for the removal of small tumours and restoration of prolactin concentrations to normal. Despite these promising early results, however, concern about the justification for this approach has grown since Serri et al reported an incidence of recurrence of up to 50% for microadenomas (< 10 mm diameter) and 80% for macroadenomas (>10 mm diameter) five years after transsphenoidal sellotomy and selective removal of prolactinomas.`This concern is highlighted by the availability of effective alternative treatment for such patientsnotably, dopamine agonists, such as bromocriptine, or radiotherapy, or both. " ''We report the results of transethmoidal surgery in 35 patients with prolactinomas. Our results cover five years and emphasise the importance of careful endocrine assessment in the preoperative diagnosis and subsequent management of these patients. Our data are supported by detailed immunohistochemical analyf ' of tumour material removed at surgery.

Ten year follow up of microprolactinoma treated by transsphenoidal surgery

“…In 1983 Serri et al reported an incidence of apparent recurrence of hyperprolactinaemia in 50% of patients (12/24) with microprolactinoma five years postoperatively 2. Our findings1 and those of Scanlon et al3 and Bevan et al4 did not confirm this observation. Other American and European authors, however, have reported higher recurrence rates.…”

Endoscopic endonasal transsphenoidal surgery: surgical results of 228 pituitary adenomas treated in a pituitary center

“…The superiority of endoscopic surgery for hormonal control of prolactinomas has not been conclusively demonstrated. In the literature, a wide range of different results are presented for tumors operated by the microsurgery technique (54-86%) [24,32,[38][39][40]. A randomized study comparing the results of the endoscopic endonasal technique versus the sublabial microsurgical approach demonstrated similar results in terms of prolactinoma resection and hormonal control [26].…”

Factors influencing the outcome of microsurgical transsphenoidal surgery for pituitary adenomas: A study on 184 patients

“…Remission rates in large series of surgically treated prolactinomas vary between 54% and 86%. [53][54][55][56] In this study, biochemical cure was achieved in 72.7% of patients.…”