Transsphenoidal microsurgery for prolactin-secreting pituitary adenomas

Abstract

The results of transsphenoidal microsurgery in 100 women with the amenorrhea-galactorrhea syndrome caused by pituitary adenomas associated with hyperprolactinemia (prolactinomas) are presented. As the surgical results were closely related to the preoperative levels of serum prolactin, the patients were divided into the following 2 groups: patients with preoperative prolactin < 200 ng/ml (Group 1); those with preoperative prolactin > 200 ng/ml (Group 2). The results in Group 1 (72 patients) were significantly better. In this group, 56 (78%) patients regained normal menstrual cycles; 55 (76%) had return of elevated prolactin levels to normal following surgery. In Group 2 (28 patients), only 11 (39%) resumed normal menstrual periods postoperatively; 13 (46%) had return of elevated prolactin levels to normal. There was good correlation between tumor size and the preoperative level of prolactin. Of the 72 women in Group 1, 58 (81%) had tumors < 1 cm (microadenomas); of the 28 women in Group 2, only 4 (14%) had tumors of that size. All patients with visual field deficits preoperatively improved or had a normal visual examination postoperatively; none was made worse by surgery. Four patients (3 in Group 2) have required additional surgery and/or irradiation. In the last 6 patients of the series, contrast-enhanced coronal computerized tomography slices made with the updated General Electric scanner detected 5 microadenomas. Considering that a relatively high percentage of sellar polytomograms are negative in patients with proven microadenomas (i.e., only 40 of 72 patients in Group 1 had abnormal polytomography) it is likely that sellar polytomography will significantly decrease in importance in the diagnostic work-up of these patients. A rationale for transsphenoidal microsurgery in these patients as opposed to other forms of management, such as bromocriptine therapy and irradiation, was provided.