Indications for surgery in the treatment of hyperprolactinemia

Indications for pituitary surgery have been described in the medical literature, but they do not necessarily apply to prolactin-secreting (PRL-secreting) pituitary microadenomas or macroadenomas. Reviews of pituitary surgery done for microprolactinomas and macroprolactinomas have not demonstrated any significant beneficial effect on the clinical course of the hyperprolactinemia. At the same time, such surgery has been associated with definite risks, including an overall mortality of 0.9%. There is even the possibility that surgery and radiation for benign pituitary adenomas can facilitate malignant transformation and metastasis. Therefore, medical treatment with a dopamine agonist is the primary choice for all PRL-secreting microadenomas and macroadenomas. Referral for surgical evaluation is reserved for patients in whom neurologic deficits, such as visual field impairment or cranial nerve deficits, do not improve with medical therapy and for certain other, rare situations.