Medical versus surgical treatment of prolactinomas: an analysis of treatment outcomes

Martin J. Rutkowski, Manish K. Aghi

Research output: Contribution to journalReview article

1 Scopus citations

Abstract

Introduction: Prolactinomas are unique tumors that may go into both hormonal and radiographic remission with dopamine agonist therapy or transsphenoidal surgery. Regardless of modality, the goals of therapy remain the same: (1) biochemical remission, including reduction of prolactin and normalization of sex hormones; (2) radiographic tumor control, with a range including prevention of tumor growth, tumor regression, or complete tumor resolution; (3) resolution of preoperative symptoms, including those that are hormonal or neurologic; and (4) prevention of new hypopituitarism or new neurologic symptoms. Areas covered: In the following review, we performed a search of the literature using keywords ‘prolactinoma,’ ‘dopamine agonist,’ ‘surgery,’ ‘cost-effectiveness,’ ‘recurrence,’ and ‘complication’ to compare the relative merits of medical versus surgical therapy for prolactinoma, including special circumstances such as cystic tumors, pregnant patients, and the cost-effectiveness of different strategies. Expert commentary: Medical therapy can offer a cure, but surgery provides an important adjunct to patients with resistance or intolerance to dopamine agonists, and offers excellent outcomes including when combined with continued postoperative medical therapy. Further head to head comparisons will benefit patients and practitioners weighing the relative risks and benefits of medical and surgical intervention, including the issue of their relative cost-effectiveness.

Original languageEnglish (US)
Pages (from-to)25-33
Number of pages9
JournalExpert Review of Endocrinology and Metabolism
Volume13
Issue number1
DOIs
StatePublished - Jan 2 2018
Externally publishedYes

Keywords

  • adenoma
  • dopamine agonist
  • pituitary
  • Prolactinoma
  • surgery

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism

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