Kandeel, M., Elhawary, M., Elghannam, O. (2019). Does Dopamine Agonist Hormonal Therapy for Macro-Prolactinoma Affect Future Surgery?. The Egyptian Journal of Hospital Medicine, 74(4), 899-904. doi: 10.21608/ejhm.2019.25556
Mohamed Raafat Kandeel; Magdy A. Elhawary; Osama Elghannam. "Does Dopamine Agonist Hormonal Therapy for Macro-Prolactinoma Affect Future Surgery?". The Egyptian Journal of Hospital Medicine, 74, 4, 2019, 899-904. doi: 10.21608/ejhm.2019.25556
Kandeel, M., Elhawary, M., Elghannam, O. (2019). 'Does Dopamine Agonist Hormonal Therapy for Macro-Prolactinoma Affect Future Surgery?', The Egyptian Journal of Hospital Medicine, 74(4), pp. 899-904. doi: 10.21608/ejhm.2019.25556
Kandeel, M., Elhawary, M., Elghannam, O. Does Dopamine Agonist Hormonal Therapy for Macro-Prolactinoma Affect Future Surgery?. The Egyptian Journal of Hospital Medicine, 2019; 74(4): 899-904. doi: 10.21608/ejhm.2019.25556
Does Dopamine Agonist Hormonal Therapy for Macro-Prolactinoma Affect Future Surgery?
Department of Neurosurgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Abstract
Background: Controversy regarding first line therapy for macro-prolactinoma patients had been of debate for many decades. Several reports suggested that dopaminergic agents (DAs) medications are accused for prolactinoma fibrosis. Whether fibrosis has positive or negative influence on the management of prolactinomas is still unclear. Aim of the work: was to compare the intraoperative tumor consistency, intraoperative difficulties and complications both pre- and post-operative between macro-prolactinoma patients who received DA medications and who did not receive prior to surgery. Patients and Methods: Twenty-five macro-prolactinoma patients who underwent primary pituitary surgery, sub-labial trans-sphenoidal microscopic removal, of macro-prolactinoma grouped into two groups. Group 1 included patients who were treated by DA medication, combined therapy with Bromocreptine and Cabergoline, prior to surgery for at least 3 months. Group 2 included patients who didn’t receive any preoperative DA medications. We compared the intra-operative texture of the tumor, intraoperative and post-operative complications together with the extent of surgical excision and hormonal remission achieved. Results: No significant statistical difference as regards intra-operative tumor consistency in relation to preoperative hormonal treatment. The rate of intra-operative and post-operative complications has no relation to the pre-operative hormonal therapy by DAs nor to the intraoperative tumor consistency. The only factor that affect the extent of surgical excision is the pre-operative tumor size graded by KNOSP classification and this extent of surgical excision has direct implication on the post-operative hormonal remission rate. Conclusion: It could be concluded that there is no risk of more tumor fibrosis nor increase in the complication rate due to DA medication prior to surgery. So, using dopamine agonist as the primary treatment for prolactinoma while Surgical excision is deferred for cases of failure or intolerance of side effects of the the hormonal therapy.
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