Surgical treatment of microprolactinomas: pros

Medical therapy with dopaminergic agonists (DAs) has been used for several decades for the treatment of both micro- and macroprolactinomas, without much differentiation between the two conditions. While most cases respond well to DAs in terms of prolactin normalization and control of tumor growth, DAs are often needed for many years, or even for lifetime. Concerns have been raised recently about the possible side effects of long-term use of these medications on the anatomy and function of the heart valves. While macroprolactinomas are rarely surgically curable, pituitary surgery in expert hands is a safe and effective method to permanently cure microprolactinomas, with long-term cure rates around 70 %. In this article, I will review the data on safety of DAs an on the effectiveness and safety of surgery, and I will make an argument that surgery should be offered as a possible therapy to microprolactinoma patients, provided that an experienced pituitary neurosurgeon is available.