Effect rates of different modalities for treatment of prolactin adenomas

Results of treatment of 963 patients with prolactin adenomas described in the literature were reviewed. The patient population was stratified into four subgroups: women and men with serum prolactin levels above and below 100 ng/ml for each of the treatment modalities: transsphenoidal surgery, bromocriptine, heavy ion radiation, conventional radiation, and transsphenoidal surgery plus conventional radiation. The five largest series within each subgroup were included. Success rates and recurrence rates were calculated for: (1) reduction of tumor size, (2) normalization of serum prolactin levels, and (3) normalization of other pituitary functions. Complication rates were calculated for procedural impairment of other pituitary functions. Transsphenoidal surgery was found to be the most effective treatment for lasting control, and bromocriptine for temporary control, of prolactin adenomas. Recurrent adenomas were most effectively treated by transsphenoidal surgery if serum prolactin levels were below 100 ng/ml. If serum prolactin levels were above 100 ng/ml, bromocriptine was the most effective treatment. Heavy ion radiation, with success rates comparable to those of transsphenoidal surgery and bromocriptine, but with lower recurrence rates, may eventually prove the most effective treatment of all.