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Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Prolactin reduction after combined therapy for prolactin macroadenomas.
1Division of Radiation Oncology, North Shore University Hospital, Manhassett, New York.
Neurosurgery
|April 1, 1991
Summary
For prolactin macroadenomas with very high prolactin levels, surgery and radiotherapy alone are insufficient. Combining these treatments with a dopamine agonist effectively normalizes prolactin levels.
Area of Science:
- Endocrinology
- Neurosurgery
- Oncology
Background:
- Prolactin macroadenomas with markedly elevated prolactin levels present treatment challenges.
- Current guidelines for multimodality therapy are lacking for these specific cases.
Purpose of the Study:
- To evaluate the efficacy of transsphenoidal surgery and postoperative radiotherapy, with or without dopamine agonist therapy, for prolactin macroadenomas.
- To establish treatment guidelines for patients with extreme hyperprolactinemia due to prolactinomas.
Main Methods:
- Retrospective review of 21 patients with prolactin levels > 200 ng/ml treated with transsphenoidal surgery and radiotherapy.
- Analysis of treatment outcomes, including prolactin level reduction and normalization, with or without dopamine agonist use.
Main Results:
- Surgery and radiotherapy alone achieved a 90% prolactin reduction but failed to normalize levels in 7 patients.
- The combination of surgery, radiotherapy, and dopamine agonist resulted in a 99.5% prolactin reduction and normalization in all 12 patients treated with this approach.
- Spontaneous physiological improvement was infrequent; however, some patients achieved fertility.
Conclusions:
- Multimodality therapy including dopamine agonists is crucial for achieving endocrine control in prolactin macroadenomas with extreme hyperprolactinemia.
- A treatment strategy incorporating surgery, radiotherapy, and dopamine agonists is recommended for optimal outcomes in these challenging cases.
