Role of surgery in the treatment of microprolactinomas

Couldwell, William T.; Rovit, Richard L.; Weiss, Martin H.

doi:10.1016/s1042-3680(02)00090-6

Cited by 37 publications

(15 citation statements)

References 16 publications

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“…Although most authorities recommend transsphenoidal surgery as a second line option for prolactinomas, some experts continue to advocate surgery as a potentially curative procedure in selected patients (72,92,95,96). These experts propose that young patients with microadenomas who have a good chance of cure could avoid the need for extended medical therapy.…”

Section: H Surgical Vs Medical Therapymentioning

confidence: 99%

Advances in the Treatment of Prolactinomas

et al. 2006

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Prolactinomas account for approximately 40% of all pituitary adenomas and are an important cause of hypogonadism and infertility. The ultimate goal of therapy for prolactinomas is restoration or achievement of eugonadism through the normalization of hyperprolactinemia and control of tumor mass. Medical therapy with dopamine agonists is highly effective in the majority of cases and represents the mainstay of therapy. Recent data indicating successful withdrawal of these agents in a subset of patients challenge the previously held concept that medical therapy is a lifelong requirement. Complicated situations, such as those encountered in resistance to dopamine agonists, pregnancy, and giant or malignant prolactinomas, may require multimodal therapy involving surgery, radiotherapy, or both. Progress in elucidating the mechanisms underlying the pathogenesis of prolactinomas may enable future development of novel molecular therapies for treatment-resistant cases. This review provides a critical analysis of the efficacy and safety of the various modes of therapy available for the treatment of patients with prolactinomas with an emphasis on challenging situations, a discussion of the data regarding withdrawal of medical therapy, and a foreshadowing of novel approaches to therapy that may become available in the future.

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Section: H Surgical Vs Medical Therapymentioning

confidence: 99%

Advances in the Treatment of Prolactinomas

et al. 2006

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“…For large invasive tumors that are resistant to medical therapy, surgical debulking may be necessary to reduce the tumor size in an attempt to increase its sensitivity to pharmaceutical therapy [39]. With the advancement of surgical techniques, surgical intervention may be a reasonable option for individuals who have potentially curable microprolactinomas and do not wish to be on lifelong medical therapy [2,10,11,45,47,[49][50][51][52]. Surgery may also be indicated for patients who are dependent on antipsychotic medication, as dopamine agonists may agitate psychotic episodes [2,11].…”

Section: Indicationsmentioning

confidence: 99%

“…Transsphenoidal surgery performed by an experienced pituitary neurosurgeon is relatively safe and can be considered as a potentially curative treatment for patients with symptomatic microprolactinomas who do not tolerate, or do not want, lifelong medical therapy (Fig. 2) [2,10,11,45,47,[49][50][51][52]. According to a study by Turner et al [2,10,53], the clinical results and economic costs of surgical resection are comparable to those of pharmacological management over a 10 year period.…”

Section: Microprolactinomasmentioning

confidence: 99%

Update on prolactinomas. Part 2: Treatment and management strategies

Wong

Eloy

Couldwell

et al. 2015

Journal of Clinical Neuroscience

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“…With an experienced surgeon, success rates over 90% can be achieved in carefully selected young patients with small tumors and prolactin levels less than 200 g/liter (38,39). It has been proposed that it may be more economical to operate on patients with a high likelihood of surgical cure rather than relying on long-term dopamine agonist therapy (40). However, persistence of normoprolactinemia after withdrawal of cabergoline discussed above, even in macroadenomas, weakens this economic argument.…”

Section: Is There a Role For Surgery In Long-termmentioning

confidence: 99%

Long-Term Management of Prolactinomas

Schlechte

2007

The Journal of Clinical Endocrinology &Amp; Metabolism

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Prolactinomas are a frequent cause of gonadal dysfunction and infertility, especially in young women. The regulation of prolactin secretion and the efficacy of dopamine agonists in the therapy of prolactinomas are well established. The current challenges in management of prolactinomas are related to follow-up after successful therapy. Issues and questions to be addressed in this approach to long-term management of prolactinomas include the frequency of radiographic monitoring, effect of pregnancy and menopause, safety of estrogen in women taking oral contraceptives, and the potential for discontinuation of dopamine agonist therapy.

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Role of surgery in the treatment of microprolactinomas

Cited by 37 publications

References 16 publications

Advances in the Treatment of Prolactinomas

Advances in the Treatment of Prolactinomas

Update on prolactinomas. Part 2: Treatment and management strategies

Long-Term Management of Prolactinomas

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