Transsphenoidal surgery should be considered when:
โDopamine agonist treatment has been unsuccessful in lowering the serum prolactin concentration or size of the adenoma, and symptoms or signs due to hyperprolactinemia or adenoma size persist after several months of treatment at high doses.
โA woman has a giant lactotroph adenoma (eg, >3 cm) and wishes to become pregnant even if the adenoma responds to a dopamine agonist. The rationale for this approach is that if the patient becomes pregnant and discontinues the agonist for the duration of pregnancy, the adenoma may increase to a clinically important size before delivery.
sw18I thought prolactinomas usually have prolactin >200ng/ml? Her prolactin is only 40ng/ml, which made me think non-functional pituitary adenoma and pick transsphenoidal resection. +3
Young woman with irregular menses, galactorrhea, bitemporal hemianopsia found to have elevated prolactin and a pituitary microadenoma, most consistent with a prolactinoma
Key idea: Prolactin release from the anterior pituitary is inhibited by endogenous dopamine release from the hypothalamus, so we give patients with a prolactinoma dopamine agonists (bromocriptine, cabergoline) to inhibit prolactin release
Key idea: Patients with a macroprolactinoma (>10 mm) or symptomatic microprolactinoma should be started on dopamine agonists and should get a resection if the tumor is very large (>3 cm) or if the mass increases in size while on a dopamine agonist
submitted by โyotsubato(1208)
Transsphenoidal surgery should be considered when:
โDopamine agonist treatment has been unsuccessful in lowering the serum prolactin concentration or size of the adenoma, and symptoms or signs due to hyperprolactinemia or adenoma size persist after several months of treatment at high doses.
โA woman has a giant lactotroph adenoma (eg, >3 cm) and wishes to become pregnant even if the adenoma responds to a dopamine agonist. The rationale for this approach is that if the patient becomes pregnant and discontinues the agonist for the duration of pregnancy, the adenoma may increase to a clinically important size before delivery.