Transsphenoidal surgery for microprolactinomas in women: Results and prognosis

摘要

Background: Long-term dopamine agonist (DA) therapy is recommended as a first-line approach for the management of microprolactinomas. However, DA therapy may be poorly tolerated by some patients, and therefore some patients continue to prefer surgery over DA therapy. Aim: The aim of our study was to evaluate factors associated with favorable outcomes after surgical treatment of microprolactinomas in women. Methods: Thirty-two women (mean age 31.0±8.2 years) with confirmed microprolactinomas who were operated using transsphenoidal approach were included to the study. Twenty-two (61 %) women had previous DA therapy and ten (39 %) women preferred surgery as a first treatment. Mean follow-up was 4.2±2.7 years. Surgery was considered to be effective and remission achieved if serum prolactin was normal without DA therapy and there were no signs of tumor re-growth on neuroimaging. Results Nine (47.4 %) patients in whom remission was achieved did not receive preoperative DA therapy when compared to one (7.7 %) patient in whom remission was not achieved (p00.02). Remission after operation was achieved in nine out of ten (90 %) patients who did not receive DA therapy compared to ten out of 22 patients (45.5 %) who were treated with DAs (p=0.01). The independent factor associated with good outcome following surgical treatment was no preoperative DA therapy (RR= 14.57 (1.43-148.1), p=0.02). Surgical complications were permanent diabetes insipidus in two patients (6.3 %) and transient DI in five (15.6 %) patients. Conclusions: The main factor associated with favorable microprolactinoma surgery outcome in women was the absence of preoperative DA therapy.