Prolactinoma surgery

Prolactinoma Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Faizan Sheraz, M.D. [2], Anmol Pitliya, M.B.B.S. M.D.[3]

Overview

Surgery is not the first-line treatment option for patients with prolactinoma. Surgery is usually reserved for patients in whom medical therapy fails to reduce the size of the tumor.

Surgery

Indications

Medical therapy should be continued even if it is partially successful, possibly combined with surgery or radiation. Surgery is indicated in patients if medical therapy:

• Cannot be tolerated
• Fails to reduce prolactin concentration
• Fails to restore normal reproductive and pituitary function
• Fails to reduce tumor size

Transsphenoidal resection

Usually, the tumor is removed through the nasal cavity. Rarely, if the tumor is large or has spread to nearby brain tissue, the surgeon will access the tumor through an opening in the skull. The results of surgery depend on tumor size and prolactin concentrations. Surgery corrects prolactin concentrations in approximately 80% of patients with:

• Small tumors (microadenomas)
• Serum prolactin < 200 ng/ml

References

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