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Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas

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Published on: January 17, 2018

Management of prolactinomas.

¹Center for Endocrinology, Metabolism, and Nutrition, Northwestern University Medical School, Chicago, Illinois 60611.

Annual Review of Medicine

|January 1, 1989

Summary

Dopamine agonists are the primary treatment for prolactinomas (pituitary tumors). For women with large prolactinomas desiring pregnancy, surgery followed by medication is the safest approach.

Area of Science:

Endocrinology
Neurosurgery
Reproductive Medicine

Background:

Prolactinomas are the most frequent hormone-secreting pituitary tumors.
Distinguishing prolactinomas from non-secreting tumors causing hyperprolactinemia is crucial.
Hyperprolactinemia can result from hypothalamic or stalk dysfunction.

Purpose of the Study:

To outline the management of prolactinomas.
To identify optimal treatment strategies for patients desiring pregnancy.
To differentiate treatment approaches based on tumor size and reproductive goals.

Main Methods:

Review of current treatment guidelines for prolactinomas.
Analysis of therapeutic outcomes for dopamine agonist therapy.
Evaluation of surgical interventions for non-responsive or large tumors.

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Assessment of treatment safety in women desiring pregnancy.

Main Results:

Dopamine agonists are the first-line treatment for both micro- and macroadenomas.
Transsphenoidal surgery is reserved for patients unresponsive to dopamine agonists.
Dopamine agonists are safe for women with microadenomas or intrasellar macroadenomas who wish to conceive.
For women with large macroadenomas desiring pregnancy, a combination of limited transsphenoidal decompression and bromocriptine is recommended.

Conclusions:

Dopamine agonists are the mainstay treatment for prolactinomas.
Treatment strategies should be tailored to tumor characteristics and patient reproductive desires.
Surgical decompression followed by bromocriptine offers the safest approach for pregnant women with large prolactinomas.