gms | German Medical Science

Objective: Medical therapy with Dopamine-agonists (DA) is the primary treatment of choice in most patients with prolactinomas. “Classical” indications for operative therapy have been persisting hyperprolactinemia and/or insufficient shrinkage of the tumors. Focusing on a possible shift of operative indications with new DA having become more effective with less side effects during the last 15 years, we retrospectively analyzed our operative results in a series of 185 patients with prolactinomas.

Methods: Between 1990 and August 2005 we operated on 218 consecutive patients with prolactinomas, who had reliable and completed data meeting the study protocol in 185 patients. Mean follow-up time was 15.8 months. Remission rates were defined by serum PRL-levels less than 500 µU/ml. Operative indications were divided into “classical” groups such as DA side-effects, persistent hyperprolactinemia, insufficient shrinkage of tumor and “modern” groups such as cystic tumors and patients wish for an primary operative therapy.

Results: Pure surgical remission was 80.3% (is, intrasellar), 61.4% (s1, suprasellar without visual deficits), 14.7% (s2, suprasellar with visual symptoms), 25% (ps/sph, parasellar/sphenoidal) and 0% in giant tumors resulting in an overall surgical remission rate of 49.7%. Follow-up remission in combination with postoperative adjunctive DA-therapy was 72.5% (is), 67.3% (s1), 37.5% (s2), 61.5% (ps/sph) and 40% (giant) resulting in an overall combined remission rate of 60.8%. During the time periods 1990-1995, 1995-2000 and 2000-2005 we operated on patients with DA side-effects in 25%, 15.7% and 12.7% of cases as well as in patients with persistent hyperprolactinemia in 18.3%, 10% and 7.3% of cases. Thus both “classical” groups are becoming continuously less. In contrast, the number of patients with cystic tumors asking for primary operative therapy has increased (16.6%, 32.9% and 25.5%, respectively).

Conclusions: Overall remission rates after surgical treatment of prolactinomas remain excellent with an emphasis on intrasellar macro- and microadenomas. The combination of the well known low morbidity of transsphenoidal surgery with the introduction of modern, more effective and better tolerated DA has led to a change. From our point of view this has also resulted in an expansion of the indications for operative therapy including more young patients with cystic tumors, who personally wish for a primary, possible definitive surgical treatment.