TRANSSPHENOIDAL PITUITARY RESECTION FOR PREOPERATIVE DIAGNOSIS OF PROLACTIN-SECRETING PITUITARY-ADENOMA IN WOMEN - LONG-TERM FOLLOW-UP

The long term efficacy and safety of transsphenoidal resection for pre operative diagnosis of PRL-secreting pituitary adenomas in a large ser ies of women have not been described. Four hundred and nine; consecuti ve women at this university tertiary referral center undergoing transs phenoidal resection for preoperative diagnosis of PRL-secreting pituit ary adenoma were followed for a minimum of 4 yr. The objective was to determine the efficacy and morbidity of this procedure and to identify features correlating with the resolution of hyperprolactinemia. Outco me measures included referral, preoperative, surgical, postoperative h ospitalization, and long-term follow-up information, including recent PRL concentration. Follow-up was ascertained in 83% of patients who we re followed for a mean of 9.2 yr. Recurrence of hyperprolactinemia occ urred in 47% of total patients, but in only 16% with a single surgical procedure, histological diagnosis of prolactinoma, and postoperative PRL concentration of 5 ng/mL or less. The best single predictor of cur e was postoperative day 1 PRL concentration of 5 ng/mL or less. Eighty -eight percent of women desiring conception conceived within 1 yr. Glu cocorticoid-dependent hypopituitarism occurred in 23% of patients unde rgoing postoperative radiotherapy. There was no operative mortality. O perative morbidity was low. Our experience demonstrates that women und ergoing transsphenoidal surgery for diagnosis of PRL-secreting adenoma form a heterogeneous patient population. The best long term results a re achieved in the pure prolactinoma group, for whom transsphenoidal r esection is generally safe and effective.