Surgical removal of prolactinoma is indicated only when drug therapy fails or there is intolerance to the agents. Drug therapy should also be initiated primarily if vision is impaired. If this does not bring a rapid improvement, surgery is indicated.
The procedure of choice is then transsphenoidal pituitary surgery* or transfrontal pituitary surgery; transnasal surgery is now the treatment of first choice.
* Transphenoidal pituitary surgery is indicated for large or cystic prolactinomas with suprasellar extension (expansion) and lack of response to dopamine agonists.
Possible complications of surgery for a pituitary adenoma:
- Diabetes insipidus – hormone-deficiency-related disorder in hydrogen metabolism leading to extremely high urine excretion (polyuria; 5-25 l/day) due to impaired concentrating capacity of the kidneys; incidence: 6-11%.
- Anterior pituitary insufficiency (HVL insufficiency) – failure of endocrine functions (hormone function) of the anterior pituitary lobe (HVL); frequency: 6-15 %.
- Epistaxis (nosebleeds) frequency: 1-3 %.
- Injury to the internal carotid artery Frequency: 0-1.3%.
Other notes
- Gravidity (pregnancy): during pregnancy there is physiological enlargement of the pituitary gland (pituitary gland), so the risks of irreversible visual loss (sudden loss of vision) increase.
- In patients with pregnancy aspirations and distress of the optic chiasm (optic nerve junction) or large macroprolactinomas, pregnancy should be preceded by size reduction by dopamine agonist therapy or transsphenoidal pituitary surgery or irradiation, if necessary.
