Transsphenoidal Surgery for Microprolactinomas in Women: Results and Prognosis

Introduction: The aim of this study was to explore the long-term outcome of transsphenoidal surgery for microprolactinomas in women and the factors that influence the outcome. Methods: The transsphenoidal approach for pituitary adenomas was used for 346 patients at the Department of Neurosurgery of Kaunas University Hospital from 1995–2006. Of them, 85 patients (68 [80%] women, and 17 [20%] men) were operated on for prolactinomas.. Among the women, 32 micro- and 36 macroprolactinomas were diagnosed. Treatment with dopamine agonists was applied for 22 (68.8%) female patients with microprolactinoma. Mean follow-up period was 4,2 ± 2,7 years. Results: Remission after operation was achieved in 9 cases (90%) out of 10 female patients who had microadenoma and had not taken dopamine agonists before the operation, and in 10 cases (45.5%) of 22 who were treated with dopamine agonists ( P = 0.01). The transsphenoidal approach for pituitary adenomas is a sufficiently safe method; complications occurred only in 3 (9.1%) patients who underwent surgery for microprolactinomas. Independent factors predicting a good outcome of the surgical treatment were discovered by employing multivariate logistic regression. An independent prognostic factor for successful transsphenoidal surgery outcome in women with microprolactinoma was no treatment with dopamine agonists before the operation (relative risk, 14.57; P = 0.02). Conclusions: An important factor for favorable surgical outcome in women with microprolactinoma was nonuse of dopamine agonists before surgery (remission in 90% of cases).