Problems in the management of large prolactin-secreting pituitary adenomas

ABSTRACT

To determine current problems in the management of large prolactin-secreting pituitary adenomas. Retrospective study of consecutive patients with prolactin-secreting adenomas over a 10 years period. Neurosurgical division of King Khalid University Hospital, Riyadh, Saudi Arabia. Thirty-one patients four with microadenomas and 27 with macroprolactinomas. Tumour resection was performed in 22 patients transsphenoidal in 16 and transcranial in six patients were treated conservatively [dopamine agonist alone in five cases, and combined with radiotherapy in one]. Three patients refused surgery and were excluded. Surgical morbidity and mortality, postoperative basal prolactin level. Six patients [27%] became normoprolactinaemic directly after surgery; 14 patients required additional postoperative treatment. The overall rate of return of serum prolactin level to normal at last follow up was 71%. Hyperprolactinaemia was significantly reduced in a further 21% of the patients while the remaining 8% were unchanged. One patients died 40 days after transcranial surgery. Two patients developed tumour recurrences and hyperprolactinaemia relapsed in a third patient with no evidence of tumour regrowth. The failure rate of monotherapy in large prolactin-secreting adenomas is high. At present, the combination of transsphenoidal surgery and dopamine agonist therapy provides the highest control rates of the tumour and the associated hyperprolactinaemia