Prolactinoma - What about surgery?

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In general, surgery is not recommended as primary therapy for prolactinomas because the dopamine agonists are very effective and because surgery is not always curative.

For patients with microadenomas , pituitary surgery may be necessary if cabergoline or bromocriptine don’t work or if the medications cause serious side effects. Patients with macroadenomas may need surgery if there is progressive growth of the tumor despite medical therapy. The surgical outcome is highly dependent on the skill of the surgeon and surgery should only be performed by a neurosurgeon with extensive experience in transsphenoidal pituitary surgery. Radiation therapy is rarely used in the treatment of prolactinomas.

Transsphenoidal literally means ‘through the sphenoid sinus’. It is a surgical procedure to remove pituitary tumors performed by inserting the surgical instruments into the nose and through the sphenoid bone, a small butterfly-shaped bone at the base of the skull.