The use of surgery for the treatment of prolactinomas.

Success with trans-sphenoidal surgery for microprolactinomas is good (57 to 93% cure rate) but tumours can recur. Conversely, the results of surgery for macroprolactinomas are not so good (14 to 39% cure rate) and cure is rarely effected when plasma prolactin levels are > 10 U/l. Surgical therapy for prolactinoma should be reserved for patients with dopaminergic resistance or intolerance and complications (e.g. haemorrhage and rhinorrhoea) to dopamine agonist therapy. Trans-sphenoidal surgery was used to treat 11 microprolactinoma patients who had compliance problems to dopaminergic therapy. Postoperative plasma prolactin levels were normal in all patients. During follow-up (range 0.5 to 8 years, mean 3.9 years) six patients remained normoprolactinaemic, four patients developed slightly elevated plasma prolactin levels ( < 0.7 U/l), and one patient developed a macroadenoma resistant to bromocriptine and CV 205-502. He underwent a second operation, followed by radiotherapy and bromocriptine. His plasma prolactin was reduced to 3.3 U/l. One patient with a prolactinoma extending into the left cavernous sinus had a tumour cyst in the left temporal lobe. During treatment with CV 205-502 he developed a haemorrhage in the tumour cyst necessitating craniotomy.