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Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
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Extensive experience in the management of macroprolactinomas
Anna I Green1, Mark Sherlock, Paul M Stewart
1Department of Endocrinology, Queen Elizabeth Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK.
Clinical Endocrinology
|February 4, 2014
Summary
Dopamine agonist (DA) therapy alone is the optimal first-line treatment for macroprolactinomas, preserving pituitary function better than surgery or radiotherapy. Surgery and radiotherapy are best reserved for DA-resistant or intolerant cases.
Area of Science:
- Endocrinology
- Neurosurgery
- Oncology
Background:
- Macroprolactinomas are pituitary tumors.
- Treatment options include dopamine agonists (DA), surgery, and radiotherapy.
Purpose of the Study:
- To assess the outcomes of different treatment modalities for macroprolactinomas.
- To compare pituitary function after various treatments.
Main Methods:
- Retrospective case-note study of 100 patients with macroprolactinoma.
- Compared outcomes between DA-only therapy and surgery/radiotherapy groups.
- Assessed prolactin levels, endocrine status, symptoms, and tumor shrinkage.
Main Results:
- Non-medical therapy (surgery/radiotherapy) group had higher rates of gonadotrophin, TSH, and ACTH deficiency.
- 79.3% of surgery patients and 71.4% of radiotherapy patients still required DA therapy.
- DA-alone therapy group showed better pituitary function preservation.
Conclusions:
- Dopamine agonist therapy alone is the optimal first-line treatment for macroprolactinomas.
- Surgery and radiotherapy should be reserved for patients intolerant or resistant to DAs.
- Most patients undergoing surgery/radiotherapy still need DA therapy.
