TRANSSPHENOIDAL ADENOMECTOMY FOR MICROPROLACTINOMAS - 10 TO 20 YEARS OF FOLLOW-UP

BACKGROUND Transsphenoidal adenomectomy is an effective treatment for microprolactinomas. However, postoperative recurrence of hyperprolacti nemia is not rare. This study was designed to evaluate the long-term o utcome of women with microprolactinomas operated on by transsphenoidal approach. METHODS We retrospectively studied 64 women with microprola ctinomas who underwent transsphenoidal adenomectomy and were followed for 10 to 20 years. RESULTS Postoperatively, 58 women (90%) had normal plasma prolactin concentrations (< 20 mu g/L). After a mean of 3.3 ye ars, during which the women were asymptomatic with normoprolactinemia, 25 (43%) had a relapse of hyperprolactinemia (greater than or equal t o 20 mu g/L). However, their evolution varied. Fifteen women had sympt omatic hyperprolactinemia. Computed tomography (CT) scans showed recur rent microadenomas in 2 women. The other 10 women had only hyperprolac tinemia. Of these women, 5 had transient hyperprolactinemia (29 +/- 4 mu g/L) for 5 years, after which prolactin declined to normal (13 +/- 3 mu g/L). The remaining five patients had elevated prolactin (31 +/- 3 mu g/L) throughout the follow-up period (10 to 20 years). CT scan di d not show recurrent adenomas in these women. Thirty-three women remai ned normoprolactinemic and asymptomatic for a mean period of 12 years (range, 10 to 20 years). CONCLUSIONS In conclusion, most of the patien ts with late relapse of hyperprolactinemia have slight functional hype rprolactinemia and remain asymptomatic with no evidence of tumor recur rence.