Indications for Therapy in Patients with Prolactinomas
- Macroadenoma
- Enlarging microadenoma
- Infertility
- Bothersome galactorrhea
- Gynecomastia
- Testosterone deficiency
- Oligomenorrhea or amenorrhea
- Acne and hirsutism
Given the efficacy of medical therapy, only a small minority of patients with prolactinomas require transsphenoidal surgery or radiation therapy. Surgical cure rates, which are highly dependent on surgical skill and tumor anatomy, approach 80 to 90% for microadenomas but are less than 50% for macroadenomas.
Indications for Neurosurgery in Patients with Prolactinomas
- Increasing tumor size despite optimal medical therapy
- Pituitary apoplexy
- Inability to tolerate dopamine agonist therapy
- Dopamine agonist–resistant macroadenoma
- Dopamine agonist–resistant microadenoma in a woman seeking fertility, if ovulation induction is not appropriate
- Persistent chiasmal compression despite optimal medical therapy
- Medically unresponsive cystic prolactinoma
- In women seeking fertility, macroadenoma in close proximity to optic chiasm despite optimal medical therapy (prepregnancy debulking recommended)
- Cerebrospinal fluid leak during administration of dopamine agonist
- Macroadenoma in a patient with a psychiatric condition for which dopamine agonists are contraindicated
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