Pituitary Surgery: An Alternative to Dopamine Agonists for the Treatment of Microprolactinomas

Introduction

Microprolactinomas are typically treated with dopamine agonists. However, little information is available on the outcomes of patients treated with surgery. This study reports a large series of patients who underwent pituitary surgery for microprolactinoma and evaluates the effectiveness and safety of this approach.

A Cohort Study on Microprolactinoma Surgery

Between January 2008 and October 2020, 114 adult patients with microprolactinomas underwent surgery at an expert neurosurgical center. The procedure used was an endoscopic endonasal transsphenoidal approach. Patients included in the study had a microprolactinoma with no obvious cavernous sinus invasion on MRI. Prolactin levels were measured before and after surgery.

Study Results

🔹 Median follow-up: 18.2 months (ranging from 2.8 to 155 months)
🔹 Cure rate: 88% of patients achieved remission after surgery.
🔹 Disease-free survival rate: 90.9% at 1 year and 81% at 5 years.
🔹 Predictive factor for remission: Preoperative prolactin levels were a key indicator of surgical success.
🔹 Rare postoperative complications: No severe pituitary deficiency was observed, with only one case of diabetes insipidus and one cerebrospinal fluid leak, both successfully treated.

Conclusion

For well-selected patients, pituitary surgery performed by a specialized team is an effective and safe alternative to dopamine agonists for the treatment of microprolactinomas.