Prolactinoma: Surgical Treatment and Outcome

ABSTRACT

Thirty-seven patients with prolactinoma treated over a seven-year period were retrospectively reviewed. During the same period, a total of 104 patients with pituitary adenoma were treated at our hospital, and among them, prolactinoma was the most frequently occurring tumor(35.6%); it was followed by nonfunctional adenoma and growth hormone-secreting adenoma. A female preponderance was observed with a male to female ratio of 13 .1. Prolactinoma patients were diagnosed at a younger age than pituitary adenoma patients in general; it seemed that the typical symptoms of prolactin excess facilitated early diagnosis. Tumors were classified as microadenoma(n=13) or macroadenoma(n=24) according to the their largest diameter as seen on CT or MRI images. Clinical symptoms were related to mass effect(visual field defect, loss of visual acuity, headache) and/or hormone excess(amenorrhea, galactorrhea). Mean preoperative serum prolactin level was 1027.9ng/ml(range, 39-14945), and this fell to a postoperative mean of 767.8ng/ml(2-10202). In patients with a preoperative serum prolactin level below 200ng/ml, ameorrhea improved in 76.5% of cases and serum prolactin level normalized in 73.7%, but in cases where this level was over 200ng/ml, amenorrhea improved in only 30% of cases and serum prolactin level returned to normal in only 22.2%. It appears that surgical outcome was mostly influenced by the preoperative serum prolactin level.