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KMID : 0191120210360150097
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Journal of Korean Medical Science
2021 Volume.36 No. 15 p.97 ~ p.97
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Long-term Outcome of Microscopic Transsphenoidal Surgery for Prolactinomas as an Alternative to Dopamine Agonists
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Park Kawng-Woo
Park Kwang-Hyon
Park Hye-Ran
Lee Jae-Meen
Kim Yong-Hwy
Kim Dong-Young
Won Tae-Bin
Kong Sung-Hye
Kim Jung-Hee
Shin Chan-Soo
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Abstract
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Background: Although 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.
Methods: In 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).
Results: The 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.
Conclusion: TSA can be considered a safe and potentially curative treatment for selective microprolactinomas as an alternative to treatment with a long-term DA.
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KEYWORD
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Pituitary Surgery, Prolactinoma, Dopamine Agonist, Microscopic Transsphenoidal Surgery
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