Prolactin adenoma is a type of pituitary tumor that accounts for more than 40% of the total number of pituitary adenomas. Clinical manifestations are mainly: headaches, menstrual disorders and amenorrhea in women, breast lactation during non-lactating periods, and in male patients, mainly in the form of decreased libido and impotence. Prolactin adenomas can be divided into microadenomas, macroadenomas, and giant invasive adenomas according to their size. First of all, let’s talk about microadenomas: small tumors less than 1cm are called microadenomas, which are more common in clinical women. This is not to say that the incidence is low in men, but because elevated PRL levels in the body can lead to menstrual disorders or even amenorrhea and lactation in the early stages, many female patients are found to have pituitary tumors when they undergo gynecological treatment, and thus get the opportunity for early detection and treatment. In contrast, male patients show symptoms of decreased libido and sexual function, and most of them even think it is related to various external factors such as exertion and alcohol consumption, so they do not pay attention to it and neglect to consult a doctor. One of my male patients had a pituitary tumor discovered during a physical examination at his workplace, and the tumor was nearly 4 cm. The treatment of microadenoma: At present, domestic scholars have different opinions on this, some advocate drug treatment, using small doses of bromocriptine to inhibit the growth of the tumor and make it shrink. Some advocate the use of medication and small doses of bromocriptine to inhibit the growth and shrink the tumor, while others advocate surgical excision through the nasal-paranasal sinus approach before the tumor causes more serious symptoms, in order to achieve the purpose of treatment in a short period of time. There are many different opinions on this, and they are still in their own way. Which treatment is the most suitable for microadenoma? First of all, drugs can relieve the symptoms and inhibit the growth of tumor, or even make the tumor disappear, but most of the patients find that symptoms such as menopause and lactation reappear after stopping the drugs, and the tumor is found to recur after examination, which is due to the fact that although the tumor is shrunken to invisible to the naked eye due to drug treatment, the tumor cells mixed with normal pituitary tissue are still waiting for the opportunity to make trouble. Once the drug is discontinued, they will rise again and jump out to make trouble, much like the two sides of the enemy, you enter and I retreat. Therefore, almost all patients need lifelong medication. I met a patient who had been on the medication for nearly 10 years and was adamant about surgery as soon as she arrived at the clinic, saying, “I was afraid of surgery, so I chose to take the medication. I was glad that I was wise enough to escape from the stabbing. But then I found that I couldn’t stop taking it, because as soon as I stopped taking it, my menstruation stopped and my breasts started to flow again after a little bit of time. I’m scared, when is this going to end?” Her tumor was very small, still about 1cm after nearly 10 years because of the medication. I performed transsphenoidal surgery for her and found that her tumor was hard and tough, which was mainly due to the tumor fibrosis during long-term medication, and the surgery was much more difficult than the pituitary tumor patients of the same size who chose surgery directly. She was discharged from the hospital after 3 weeks of hospitalization, and she had regular endocrine and MRI checkups according to our medical advice. For pituitary microadenoma, I prefer surgery. Especially for women who have not had children, the chance of miscarriage is much higher than that of normal pregnant women if they take drugs to get pregnant with tumor, and because of the increase of estrogen level during the perinatal period, it will stimulate the growth of tumor, and there are many unsafe risks for their health and future birth. It is important to be cautious. The second one is macroadenoma: it is larger than 1cm and less than 4cm in diameter, and it is common in clinical practice without the tendency of gender. The treatment is relatively uniform, between microadenoma and macroadenoma, and both surgery and medication are available. Some patients want to shorten the treatment period, such as the friend I mentioned above whose tumor was found in a physical examination. He was adamant about choosing the former after talking to me and understanding the pros and cons of surgery and medication in detail. “I am a person who hates trouble, it’s too much trouble to take medicine for so long, and it’s still hard to escape from this knife in the end, then it’s better to just receive a knife, anyway, it’s done by anesthesia to fall asleep, and I won’t feel any pain.” Such courageous patients are really not many, but his analysis also has some truth. Although patients with macroadenoma can choose medication in the early stage, after a period of time when the tumor shrinks to a certain level and the PRL level is controlled normally, transsphenoidal surgery is recommended to avoid a lifetime of medication. Some of you may say, in this case, it is better to choose surgery directly, so why waste time and energy to take medication? In fact, for clinical treatment, for all surgical procedures, the smaller the tumor, the lesser the surgical risk and postoperative complications caused by local damage caused by surgery. So here, drug therapy still has its profound clinical significance. At the same time, for those patients who are old and frail and have their own contraindications to surgery and cannot tolerate surgery, taking drugs to control tumor growth undoubtedly provides a great degree of protection for their future quality of life. When it comes to this, some friends may ask, “Is it better to operate on microadenoma, take medicine or open surgery for large adenoma, or is there no one who can prefer to take medicine? I can tell you responsibly: there is! It is the last category of prolactin adenoma that will appear soon: giant invasive adenoma. I have described this tumor in more detail in the second serial on pituitary tumor diagnosis and treatment: more than 4 cm in diameter, aggressive growth, large size, running like a bandit to occupy an area with fish adjacent. For example, the optic nerve, when compressed, causes loss of vision in both eyes, small field of vision, and even blindness. The pituitary gland, which is its home base, is under prolonged pressure, resulting in clinical manifestations of hypopituitarism such as peripheral weakness, marked loss of libido, and even impotence. In such patients, the PRL level is more than 1000ng/ml. The reasons for this are mentioned earlier: because the symptoms are not obvious in early male patients, although most patients have more or less different degrees of hypoactive sexual desire and hypogonadism, they are not taken seriously and treatment is easily delayed. Or visit a male doctor to check for specialist aspects, thus allowing the real culprit to become a leak. Including the patient above who asked for determined surgery, I think he probably would have fallen into this category if he hadn’t been discovered occasionally during his unit physical exam. Now that the culprit has been identified, we can no longer let it go unpunished, so what kind of treatment will bring it to justice? Again, the clinical opinion is divided: some scholars follow a more traditional approach, arguing that surgical treatment should be taken first to achieve optic nerve decompression and relieve the symptoms in terms of vision, followed by drug treatment. It is like striking off a small group of robbers first, giving them a warning, and then using a recruiting approach to slowly make them abandon evil for good. However, this approach is riskier and more difficult. An aggressive tumor is like a consistently arrogant bandit, a small lesson is not enough to make it put down its butcher’s knife, unless it is suppressed with great effort for a long time, it will soon come back again. Complete resection is almost impossible, and then post-operative recurrence is in a sense inevitable. Although drugs can control tumor growth in most patients, they need to be used in high doses for a long time, and their side effects and recurrence after stopping are like a hidden enemy in danger. Therefore, I propose another treatment method, that is, first of all, to choose medication to inhibit the growth of tumor and make it slowly shrink. For patients who are sensitive to medication, within a few months of medication, even without surgery, the effect of optic nerve decompression will be achieved, and endocrine level will be monitored regularly according to medical prescriptions, and medication will be adjusted according to the magnitude of PRL reduction. At this time, the residual tumor will be cut out as much as possible, and even though small doses of medication are still needed after surgery, most patients do not need long-term medication. This not only reduces the risk of surgery but also reduces the chance of recurrence after surgery, and the cost and suffering of the patient is much lower than that of traditional surgery, which is my preferred treatment method. A young man of 21 years old had a brain tumor bigger than an egg and he didn’t know it. It is better to use the method of inviting and dividing the internal core of the bandits, so as to make them shake and disperse their hearts and minds, and slowly turn them into pieces. In the end, we will deal a complete and devastating blow to the small group of recalcitrant core elements, so that they will not be able to recover from this situation. After that, as long as appropriate suppression is implemented, the potential hidden problems can be completely eliminated and the country will return to a peaceful and prosperous time. The young man happily accepted my advice, and after only six months of taking the medicine, the “big egg” turned into a “peanut”, and I personally operated on him. I’m glad I listened to you, otherwise I would have been left with an ugly scar on my head. I’m glad I listened to you, otherwise I would have been left with an ugly scar on my head. You must give me a good look when I have a review to see if all the robbers in my head have been eliminated.” Drugs are the preferred way to treat giant aggressive prolactin adenomas, but not all patients are sensitive to such drugs; in other words, not all patients are so lucky. There is no shortage of patients for whom surgery is the only treatment option, as the tumor does not shrink despite the use of drugs to control PRL to normal. In fact, for the fast-paced life in modern society, it is not enough to maintain our health by moderate exercise and reasonable work and rest alone, and in the case of the pituitary tumor mentioned above, whether it is medication or surgery, it is just a way to mend the situation and add a lot of misery to our life. Only when we have regular checkups for our body and nip the disease in the bud can we really prevent it from happening and keep our health!