Endoscopic Endonasal Transsphenoidal Surgery for Microprolactinomas and Mesoprolactinomas as an Alternative to Dopamine Agonist Therapy

• Main Authors: Wong, Anni, Mendelson, Zachary S., Azad, Tareq, Eloy, Jean A., Liu, James K.
• Format: Conference Proceeding
• Language: English
• ISSN: 2193-6331; 2193-634X
• DOI: 10.1055/s-0035-1546478

Objective: Dopamine agonist therapy remains the gold standard of treatment for prolactinomas because of its high success rates of normalization of hyperprolactinemia and tumor control, but it is not without its disadvantages. Medical treatment is a life long commitment where withdrawal of the drug often results in recurrence of hyperprolactinemia and related clinical symptoms. A moderate percentage of those on dopamine agonist therapy are unresponsive or are intolerant to many of its adverse side effects. Surgical intervention is typically indicated for those who have failed medical therapy or demonstrate progressive symptoms such as visual loss due to the tumor. As surgical techniques become more refined, surgery is increasingly chosen as primary treatment by patients. We aimed to evaluate the biochemical cure rate of small prolactinomas surgically treated by endoscopic endonasal transsphenoidal surgery, and to identify factors that predict a favorable surgical outcome. Patients and Methods: We performed a retrospective study of 17 patients who underwent endoscopic endonasal transsphenoidal surgery for small prolactinomas (size between 0 and 20 mm) including four microadenomas (< 10 mm) and 13 mesoadenomas (range, 10–20 mm). The average tumor size was 10.6 mm (range, 5–15 mm). All patients were female with a mean age of 29.8 years (range, 15–39 years). Of the 17 patients, 16 (94.1%) patients experienced amenorrhea or oligomenorrhea whereas 10 (58.8%) encountered galactorrhea. Of the 17 patients, 12 (70.6%) failed previous medical therapy because of either resistance to dopamine agonists or intolerable side effects. The remaining five patients (29.4%) chose surgical intervention as their primary treatment of choice without prior medical therapy. Results: Biochemical remission was achieved in 94.1% (100% in microadenomas and 92.1% in mesoadenomas) with a mean follow-up of 32.4 months. All patients had resolution of symptoms with complete tumor resection and no tumor recurrence. The mean preoperative prolactin level was 139.1 ng/mL (range, 33–380.6 ng/mL). The mean prolactin level on postoperative day 1 was 8.0 ng/mL (range, 0.5–31.9 ng/mL). Postoperatively, one patient developed hypocortisolemia and was treated with hydrocortisone and one patient had epistaxis that required endoscopic cauterization. There were no complications of postoperative CSF leakage, carotid injury, or visual loss. Conclusion: Endoscopic endonasal transsphenoidal surgery, in experienc