How to treat hyperprolactinemic pituitary microadenomas?

The occurrence of hyperprolactinemic pituitary microadenoma will cause many adverse effects on patients. Therefore, if you want to effectively reduce the harm, you must focus on scientific and effective treatment methods. Surgical treatment can be said to be the first choice, and there are also drug treatment and radiotherapy.

1. Surgical treatment

Surgery is the treatment of choice. It mainly includes craniotomy and transsphenoidal surgery. Selective transsphenoidal microadenoma resection can achieve endocrine remission in 95% of patients, and the function of the anterior pituitary can be restored to normal. Sometimes only normal or hyperplastic pituitary tissue is removed, but 2/3 of patients can achieve complete remission after surgery.

2. Radiation therapy

Radiotherapy can be chosen for patients with contraindications to surgery or patients with residual tumors after surgery. Radiotherapy is relatively effective for GH microadenomas, and 60%~90% of GH adenomas are sensitive to radiotherapy. Most patients achieve significant results in about 2 years, but up to 40% of patients suffer from hypopituitarism after radiotherapy. It is contraindicated in patients with visual field defects and intracranial hypertension. It has a certain effect on pituitary adenomas. It can control the development of tumors, sometimes shrink tumors, and improve visual field, but it cannot cure them fundamentally.

3. Drug treatment

Infertile women with pituitary prolactin-secreting microadenomas can generally be treated with oral dopamine agonists - cryptotidine. Literature reports that 70% of women can become pregnant after 2 months. After long-term treatment, the tumor size can be reduced and some patients can be cured. Young women who become pregnant after taking dopamine agonists may experience pituitary adenoma apoplexy or significant enlargement during pregnancy, requiring emergency surgery if necessary. Some patients may find it difficult to persist in taking Xiyinting for a long time due to severe side effects. In this case, surgical treatment can also be chosen. Bromocriptine is a semisynthetic ergotamine bioalkaloid that can stimulate the dopamine receptors of pituitary cells to reduce the effect of prolactin in the blood. Taking bromocriptine can shrink prolactinoma, restore menstruation and ovulation and pregnancy, and inhibit galactorrhea. However, bromocriptine cannot fundamentally cure prolactinoma. After stopping the drug, the tumor may continue to grow and the symptoms will reappear. In addition, bromocriptine can also relieve symptoms of growth hormone cell adenoma, but the dosage is large and the efficacy is poor.

4. Prevent infection, provide symptomatic treatment, and deal with complications accordingly if any. The main drugs for correcting cerebral edema and reducing intracranial pressure are 20% mannitol, furosemide, and dexamethasone, and even human albumin can be used. Pay attention to electrolyte and fluid balance, and replenish blood loss during surgery.