Surgical treatment for pituitary prolactinomas

WU Jie; GAO Liang; ZHOU Zhenggan; XIA Ming; SUN Hongjie; DING Chongxue; ZHOU Kai; ZHANG Tingrong; LI Shaoshan

doi:10.13798/j.issn.1009-153X.2025.09.001

Abstract：Objective To investigate the clinical characteristics and surgical outcomes of pituitary prolactino-mas.Methods A retrospective analysis was conducted on the clinical data of 103 patients with pituitary prolactinomas who underwent surgical treatment at The First Affiliated Hospital of Xinjiang Medical University between January 2020 and De-cember 2024.Results Macroadenomas were the most common type in both male and female patients.However,the propor-tion of microadenomas was significantly higher in females(P<0.05),while the proportion of giant adenomas was significantly lower in females(P<0.05).The Knosp grade of tumors was mainly distributed in grades 3-4 in males and grades 0-2 in females.Preoperative gonadal hormone(estradiol,testosterone)abnormalities were the most common(77.67%),followed by thyroid dysfunction(16.50%),with cortisol abnormalities being the least frequent(5.83%).Preoperative hormone deterioration rates were lowest in microadenomas,followed by giant adenomas,and highest in macroadenomas.Among the 103 cases,gross total resection was achieved in 33,subtotal resection in 38,and partial resection in 32.Postoperative normalization rates for cortisol and gonadal hormones were highest in microadenomas,followed by macroadenomas,and lowest in giant adenomas.Preopera-tively,there was no thyroid dysfunction in microadenomas.The postoperative normalization rate of thyroid function was higher in macroadenomas than in giant adenomas.Intraoperative cerebrospinal fluid(CSF)rhinorrhea occurred in 21 cases,which improved with conservative treatment or lumbar cistern drainage.No new cases of CSF leakage occurred postoperatively.Post-operative complications included epistaxis(5 cases),intracranial infection(21 cases),and central diabetes insipidus(4 cases).Multivariate logistic regression analysis showed that the extent of tumor resection and gender were independent influencing factors for postoperative biochemical remission in patients with pituitary prolactinomas(P<0.05);while Knosp grade and tumor size were independent influencing factors for the gross total resection rate of pituitary prolactinomas(P<0.05).Conclusion For pituitary prolactinomas,timely surgery for microadenomas and macroadenomas can alleviate hormone levels,reduce depen-dence on medication,shorten the overall disease course,and can be considered as a first-line treatment.Giant adenomas have a low rate of biochemical remission after surgery.Asymptomatic giant adenomas should be actively managed with medication within the patient's tolerance.However,for patients with significant mass effects due to large tumor size,tumor apoplexy,or drug intolerance,active surgery is required to relieve symptoms.