Endocrine Abstracts

Background and Aim: Prolactinoma is the most common type of functional pituitary tumor in adults. Giant prolactinomas are defined as tumors achieve a diameter >4 cm and often have very high serum prolactin level. In our previous study showed that endoscopic endonasal pituitary surgery is a very convenient procedure for the patient due to low morbidity and high efficiency. In this study we evaluated endoscopic endonasal pituitary surgery series in patients with prolactinoma.

Methods: We, therefore present a retrospective analysis of the early results of 151 consecutive prolactinoma cases operated by the seniour author (MB) at Hacettepe University, Department of Neurosurgery over a period of 7 years.

Results: A total of 151 patients, 81 (53.3%) female and 70 (46.7%) male, mean age 35.7±13.6 year (range 14–73 year), underwent endoscopic endonasal transspenoidal surgery for prolactin pituitary tumors. On the basis of MRI data, 21 patients (13.8%) had a microadenoma, 123 (80.9%) had a macroadenoma, and the remaining 8 (5.3%) had a giant adenoma. Cavernous sinus invasion was identified in 23 tumors by MRI, and confirmed by histology (n=15). Presenting symptoms included visual disturbance in 22 cases. Pathological diagnosis was atypical adenoma in 14 patients. Immediately after surgery, 34.6% patients went into remission. There were reports of postoperative four CSF leak and third menengitis ın our series. Fifty-five patients needed dopamine agonist treatment postoperatively.

Conclusion: Endoscopic endonasal approach is a safe and effective procedure for the resection of prolactinoma, particularly for the ones which are resistant to dopamine agonists and atypical adenomas. We suggest that tumors with apoplexia, compression to the optic chiasma and invasion to the cavernous sinus are suitable for this type of surgical procedure before considering medical treatment.