SURGERY COMBINED WITH DOPAMINE AGONISTS VERSUS DOPAMINE AGONISTS ALONE IN LONG-TERM TREATMENT OF MACROPROLACTINOMA - A RETROSPECTIVE STUDY

We retrospectively analysed the long-term treatment results (median 8 years) of 31 patients with macroprolactinoma. 17 patients were treated by pituitary surgery (group I) followed by long-term dopamine agonist therapy whereas 14 patients received long-term dopamine agonist thera py alone (group 2). 2 patients of group 1 and 1 patient of group 2 had external pituitary irradiation because of progressive disease. The tw o groups were comparable with respect to age, gender and initial prola ctin (PRL) levels. At the end of the observation period dopamine agoni st dosage could be reduced by 50% in group 1 and by 39.3% in group 2. Pituitary function did not change substantially during therapy. Comple te remissions (no visible tumour in CT or MRI, normal PRL levels under current dopamine agonist medication) were achieved in 23.5% of group I vs. 21.4% of group 2, partial remissions (reduction of PRL and tumou r size) in 35.3% vs. 64.3%, stable disease in 23.5% vs. 7.1% and progr essive disease in 17.7% vs. 7.1% (differences not significant). Visual field defects showed 28.4% remissions (complete and partial) in group 1 versus 50% in group 2. Dopamine agonist therapy could be stopped de finitively in only 1 patient of group 2 with an invasive macroprolacti noma. Initial surgical reduction of tumour load followed by medical th erapy does not seem to guarantee a better long-term outcome than dopam ine agonist therapy alone if the patient responds to and tolerates dop amine agonist therapy. Surgery should be reserved for non-responders, drug-intolerant or non-compliant patients, and for those with acute se vere neurological compromise.