Prolactin-producing pituitary tumors: surgical therapy

Detection of a prolactin-secreting macroadenoma of the pituitary requires neurosurgical consultation and is almost certainly best resolved by operative removal. In contrast, it is not presently clear whether surgical intervention is appropriate in the majority of patients suspected of harboring microprolactinomas, particularly in view of current uncertainties surrounding the possible antimitogenic properties of bromocryptine. The decision to recommend surgery ordinarily rests on the presumption that certain of these lesions may grow to sufficient size as to represent a permanent threat to the patient's health; other considerations include the patient's desire for fertility and the perceived risk of pregnancy in the presence of a pituitary adenoma. Assuming the patient is sufficiently reliable that we can be assured of the opportunity for regular follow-up evaluations, our group advocates a conservative posture in the majority of women in whom a microprolactinoma is suspected. In any case, it is certainly possible to reassure both the referring gynecologist and the patient that should operative intervention be indicated, the transsphenoidal approach to microprolactinomas of the pituitary is today safe and generally uncomplicated. This is due in no small measure to the contributions of such pioneering neurosurgeons as Guiot, Hardy and, of course, Cushing.