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Surgical Treatment of Prolactinomas: Potential Role as a First-Line Treatment Modality

 Eui Hyun Kim  ;  Junhyung Kim  ;  Cheol Ryong Ku  ;  Eun Jig Lee  ;  Sun Ho Kim 
 YONSEI MEDICAL JOURNAL, Vol.64(8) : 489-496, 2023-08 
Journal Title
Issue Date
Dopamine Agonists / therapeutic use ; Female ; Humans ; Pituitary Neoplasms* / drug therapy ; Pituitary Neoplasms* / pathology ; Pituitary Neoplasms* / surgery ; Prolactinoma* / drug therapy ; Prolactinoma* / pathology ; Prolactinoma* / surgery ; Retrospective Studies ; Treatment Outcome
Dopamine agonist ; pituitary adenoma ; prolactinoma ; transsphenoidal surgery
Purpose: Treatment with dopamine agonists (DAs) has been the first-line standard treatment for prolactinoma, and surgery has been reserved for drug intolerance and resistance for several decades. We evaluated whether surgery plays a primary role in prolactinoma management.

Materials and methods: We conducted a retrospective study of 210 prolactinoma patients who had received surgical treatment at our institution. We analyzed the treatment outcomes according to tumor extent, sex, and preoperative DA medication.

Results: Overall hormonal remission was achieved in 164 patients (78.1%), and complete removal was achieved in 194 patients (92.4%). When the tumors were completely removed, the remission rate increased to 84.5%. Anterior pituitary function was normalized or improved in 94.6% of patients, whereas only 4.1% of patients showed worsening of hormone control. Hormonal remission was higher in patients who had not received DA preoperatively than in those who had received preoperative DA treatment. Smaller tumor size (<1 cm), no invasion into the cavernous sinus, and female sex were predictors of good surgical outcomes.

Conclusion: Although DAs remain the first-line standard treatment for prolactinomas, surgery can be an excellent option and should be considered as an alternative primary treatment modality when patients are predicted to achieve a good surgical outcome.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
Yonsei Authors
Ku, Cheol Ryong(구철룡) ORCID logo https://orcid.org/0000-0001-8693-9630
Kim, Sun Ho(김선호) ORCID logo https://orcid.org/0000-0003-0970-3848
Kim, Eui Hyun(김의현) ORCID logo https://orcid.org/0000-0002-2523-7122
Kim, Junhyung(김준형) ORCID logo https://orcid.org/0000-0002-8908-978X
Lee, Eun Jig(이은직) ORCID logo https://orcid.org/0000-0002-9876-8370
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