Surgical Treatment of Cystic Pituitary Prolactin-Secreting Macroadenomas: A Single Center Study of 42 Patients

Abstract

This study evaluated the therapeutic effects of surgical treatment of cystic pituitary prolactin-secreting macroadenomas. The clinical data of 42 patients with cystic pituitary prolactin-secreting macroadenomas were retrospectively analyzed. Patients were divided into medication plus surgery and surgery alone groups based on the regularity of bromocriptine treatment before surgery. Both groups underwent extra-pseudocapsular transsphenoidal surgery for tumor resection, and postoperative images and clinical follow-up were retrospectively reviewed. We also evaluated patients who opted for long-term treatment with bromocriptine. In the medication plus surgery group, the long-term surgical cure rate and comprehensive remission rate were 33.3% and 41.7%, while in the surgery alone group they were 69.2% and 80.8%, respectively. No severe or permanent complications occurred, and the surgical complication morbidity rate was 10.5%. The rate of tumor progression during the long-term follow-up was 33.3% and 7.7% in the medication plus surgery and surgery alone groups, respectively. The time required for prolactin levels to return to normal in the surgery alone group was significantly faster and the proportion that returned to normal was significantly higher. Direct surgical treatment after diagnosis combined with postoperative individualized bromocriptine adjuvant therapy had better efficacy in patients with cystic pituitary prolactin-secreting macroadenomas, but its long-term effectiveness requires further follow-up.

Keywords: bromocriptine; cystic pituitary prolactin-secreting macroadenomas; extra-pseudocapsular transsphenoidal surgery.

Figure 1

Kaplan–Meier analysis of postoperative time required for PRL level to return to normal in 38 patients with cystic pituitary prolactin-secreting macroadenomas, according to the different treatment plan. They were divided into the medication plus surgery and surgery alone groups.