Indications for drug treatment: The purpose of treatment is different for different sizes of pituitary prolactin adenomas. For patients with prolactin microadenomas, the aim of treatment is to control PRL levels and preserve gonadal function and sexual function; for patients with large or giant prolactin adenomas, in addition to controlling PRL levels and preserving pituitary function in Cheng Cheng, Neurosurgery Department, Armed Forces General Hospital, it is necessary to control and reduce tumor size, improve clinical symptoms and prevent recurrence. Dopamine agonist therapy is preferred for pituitary prolactin adenoma.
Indications for drug therapy include: infertility, neurological symptoms caused by the tumor (especially visual deficits), annoying lactation, chronic hypogonadism, altered pubertal development, and prevention of osteoporosis in women due to hypogonadism. Mild hyperprolactinemia, regular menstruation, women who want to get pregnant need to be treated.
Surgical treatment of pituitary prolactin adenoma: The choice of surgical treatment for pituitary prolactin adenoma is based on a combination of the following: tumor size, blood prolactin levels, systemic condition, response to medication, the patient’s wishes, and fertility requirements. Since microadenomas account for the majority of pituitary prolactin adenomas and most of them do not grow, surgical intervention is not usually the first choice.
The goals of surgical treatment: 1. Rapid relief of endocrine abnormalities and reduction of blood prolactin to normal range.
2. Preserve normal pituitary function.
3.Minimize tumor recurrence.
4. Cerebrospinal fluid leak repair.
The vast majority of surgeries can be performed by transnasal pterygoid sinus approach, and only a few drug-resistant invasive giant pituitary adenomas require craniotomy. In recent years, with the development of instruments and equipment such as neuronavigation and endoscopy and the improvement of minimally invasive surgical techniques, experienced surgical teams can make the transsphenoidal sinus approach more precise, safer, with less damage and fewer complications. Therefore, transsphenoidal approach surgery is also an alternative to medication for patients with pituitary prolactin adenoma.