THE PLACE OF SURGERY IN THE MANAGEMENT OF PROLACTIN SECRETING ADENOMAS.

Area of Science:

• Neurosurgery
• Endocrinology
• Oncology

Background:

• Prolactinomas are commonly treated with dopamine agonists (DA), diminishing the role of surgery.
• However, surgery may still be crucial for specific indications and complications.

Purpose of the Study:

• To define the role of pituitary surgery in current prolactinoma management.
• To evaluate outcomes of endoscopic transsphenoidal surgery for prolactinomas.

Main Methods:

• Retrospective, single-center study of 12 patients undergoing primary endoscopic transsphenoidal surgery for prolactinomas (2013-2022).
• Analysis included surgical indications, prior DA treatment, remission rates, complications, pituitary function, and imaging.

Main Results:

• Most patients had macroadenomas (8/12) and prior DA treatment (9/12).
• Indications included pituitary apoplexy (5), CSF leak (3), and DA resistance (3).
• Transitory diabetes insipidus occurred in 7 patients; 2 achieved prolactin level normalization.

Conclusions:

• Surgical intervention is recommended for prolactinoma patients with neurological symptoms, DA resistance, treatment failure, or DA-related complications.
• Endoscopic endonasal surgery provides favorable outcomes and low complication rates, remaining a viable option for select cases.