Management outcomes of prolactinoma: a retrospective study from Southern Iraq

Prolactinoma is the most common pituitary adenoma. This study aims to assess the clinical presentation, treatment modalities, and outcomes of patients with prolactinomas and to identify factors that predict remission. We conducted a retrospective single-center study including patients with prolactinoma. Data from medical records were analyzed to correlate patient demographics, clinical presentation, serum prolactin (PRL) levels, and adenoma size on MRI, both at diagnosis and after initiation of dopamine agonist (DA) therapy, with treatment outcomes. A total of 205 patients were included in the study. The mean age of the cohort was 34.8 ± 12.4 years, with a female-to-male ratio of 1.5:1. Oligomenorrhea/amenorrhea was the most common presenting symptom, occurring in 112 of 122 women (91.8%). Macroadenomas accounted for 117 of 176 adenomas (66.4%). Initial treatment consisted of DA therapy in 149 patients, transsphenoidal pituitary surgery in 41 patients, and gamma knife radiosurgery in five patients. A total of 148 patients continued DA therapy at our center. After one year of DA treatment, significant adenoma shrinkage (>30%) was observed in 23 patients (34.3%), while complete adenoma disappearance occurred in six patients (8.9%). At 24 months, 25 of 88 patients (28.4%) achieved remission. Baseline PRL <10,638.2 mIU/L (500 ng/mL) and the presence of microadenoma independently predicted remission. DA therapy remains the cornerstone of prolactinoma treatment in our region and is very effective in normalizing PRL levels, shrinking adenomas, and improving clinical symptoms; DA can be used even in cases of giant prolactinomas.