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Microprolactinomas in males treated by transsphenoidal surgery
S Wolfsberger1, T Czech, H Vierhapper
1Department of Neurosurgery, University of Vienna Medical School, Vienna, Austria. stefan.wolfsbereger@akh-wien.ac.at
Acta Neurochirurgica
|November 25, 2003
Summary
Transsphenoidal surgery offers an effective treatment for male microprolactinomas. Early detection and surgical intervention can lead to a cure, avoiding long-term medical therapy.
Area of Science:
- Neurosurgery
- Endocrinology
- Oncology
Background:
- Microprolactinomas in men often present with subtle endocrine symptoms like erectile dysfunction, infertility, and gynecomastia.
- Diagnosis typically involves elevated serum prolactin levels and imaging via MRI to detect pituitary microadenomas.
Purpose of the Study:
- To evaluate the efficacy of transsphenoidal surgery as a primary treatment for microprolactinomas in men.
- To compare surgical outcomes with medical management for male prolactinomas.
Main Methods:
- Retrospective analysis of clinical data from 46 male patients diagnosed with prolactinoma.
- Eleven patients (24%) with microadenomas underwent transsphenoidal surgery between 1985 and 2000.
Main Results:
- Transsphenoidal surgery achieved endocrine cure (serum prolactin <25 ng/ml) in 73% of patients after a median 7-year follow-up.
- Patients with higher preoperative prolactin levels (>150 ng/ml) had less favorable surgical outcomes.
- Surgery successfully restored potency and libido in most patients, though infertility persisted in some.
Conclusions:
- Transsphenoidal surgery is a potentially curative option for early-stage male microprolactinomas.
- Early diagnosis through serum prolactin testing and high-resolution MRI is crucial to prevent tumor progression.
- Prompt surgical intervention can avoid the need for lifelong medical therapy in many cases.