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

Introduction

Microprolactinomas are typically treated with dopamine agonists. However, data on the outcomes of patients treated with surgery remain limited. This study presents a large series of patients who underwent pituitary surgery for microprolactinomas and evaluates the efficacy and safety of this approach.

A Cohort Study on Microprolactinoma Surgery

Between January 2008 and October 2020, 114 adult patients with microprolactinomas underwent surgery in a specialized neurosurgical center. The technique used was an endoscopic endonasal transsphenoidal approach. Patients included in the study had a microprolactinoma with no evident 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 leakage, 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.