Reappraising the Role of Trans-Sphenoidal Surgery in Prolactin-Secreting Pituitary Tumors.

Abstract Backgrounds: Prolactinomas represent a unique challenge for endocrinologists and neurosurgeons. Considering recent innovations in surgical practice, the authors aimed to investigate the best management for prolactinomas.Methods: A retrospective, cross-sectional and monocentric study was designed. Consecutive patients affected for prolactinomas were enrolled if treated with first line treatment with dopamine-agonist (DA) or trans-sphenoidal surgery (TS). Patients carried giant prolactinomas and those with a follow-up < 12 months were excluded. Results: 259 patients were enrolled. The first treatment was DA for 140 patients and TS for 119 cases. 146 of 249 patients (58.6%) needed a second therapy. Mean follow up was 102.2 months (12-438 months). Surgery highly impacted on the cure rate, in particular in females (p=0.0021) and in microprolactinomas (p=0.0020). Considering multivariate analysis, female gender and surgical treatment in the course of clinical history were the only independent positive predictors of cure at the end of 5 years follow-up (p=0.0016, p=0.0005). The evaluation of serum prolactin (24 hours after TS) revealed that 86.4% of patients with post-operative PRL≤10 ng/ml resulted cured at the end of follow-up (p< 0.0001).Conclusion: According to our experience, surgery allows a high cure rate of prolactinomas, particularly in females with microadenoma, with a good safety profile. TS for prolactinomas should be considered as concrete option, during the multidisciplinary evaluation, in centers of reference for pituitary diseases.