Surgical Outcomes in Hyporesponsive Prolactinomas: Analysis of patients with Resistance or Intolerance to Dopamine Agonists
- 1 January 2005
- journal article
- Published by Springer Science and Business Media LLC in Pituitary
- Vol. 8 (1), 53-60
- https://doi.org/10.1007/s11102-005-5086-1
Abstract
Surgery for prolactinoma patients is usually reserved for those who are intolerant of or have an inadequate response to medication. We report the results of surgical treatment in these patients. Methods: We retrospectively analyzed a consecutive series of patients with histopathologically confirmed prolactinomas; two patients treated with craniotomy and 77 patients with prolactinomas treated by transsphenoidal surgery between 1993 and 2003. We evaluated symptomatic patients who did not tolerate or did not respond to dopamine agonist therapy (persistent hyperprolactinemia and/or no shrinkage of tumor mass). We report remission rates, prolactin levels, and medications either not tolerated or ineffective. Results: Eighteen patients were intolerant of medical therapy (nine with macroadenomas and nine with microadenomas). Postoperatively, 12 patients (67%) achieved normalization of prolactin and relief of symptoms from surgery alone. Sixty-one patients were resistant to dopamine agonist therapy (45 with macroadenomas and 16 with microadenomas). Forty-six patients had both elevated prolactin levels and no shrinkage. 22 patients (36%) achieved normal postoperative prolactin levels. Ten of the remaining 39 patients required adjunctive medical therapy to maintain normal prolactin levels and relief of symptoms. Conclusions: Remission through surgery was achieved in 67% (12 of 18 patients, 4 macroadenomas and 8 microadenomas) of prolactinoma patients who fail medical therapy with dopamine agonists because of intolerance to medication. Remission was also achieved in 36% (22 of 61 patients, 12macroadenomas and 10 microadenomas) of patients who demonstrated resistance to dopamine agonist medication.Keywords
This publication has 46 references indexed in Scilit:
- The Surgical Management of Pituitary Adenomas in A Series of 3,093 PatientsJournal of the American College of Surgeons, 2001
- Prolactin Secreting Pituitary Adenomas: Analysis of 429 Surgically Treated Patients, Effect of Adjuvant Treatment Modalities and Review of the LiteratureActa Neurochirurgica, 1999
- European Experience With Cabergoline in the Treatment of HyperprolactinemiaThe Endocrinologist, 1997
- New Directions in the Treatment of HyperprolactinemiaThe Endocrinologist, 1997
- The outcome of hypophysectomy for prolactinomas in the era of dopamine agonist therapyClinical Endocrinology, 1996
- Transsphenoidal adenomectomy for microprolactinomas: 10 to 20 years of follow-upSurgical Neurology, 1996
- Low recurrence rate after partial hypophysectomyfor prolactinoma: the predictive value ofdynamic prolactin function testsClinical Endocrinology, 1992
- Vaginal bromocriptineThe Lancet, 1991
- When Bromocriptine FailsThe Endocrinologist, 1991
- INFLUENCE OF PREVIOUS BROMOCRIPTINE THERAPY ON SURGERY FOR MICROPROLACTINOMAThe Lancet, 1983