Introduction The first line treatment for prolactinomas is currently dopamine agonists (DAs). Medical management is prolonged, associated with side effects, financial, and psychological burdens. In dedicated centers, pituitary surgery is a low-risk alternative. We evaluated outcome measures of medical and surgical treatment, to assess, if the role of surgery is underestimated.

Methods We reviewed the charts of 4,660 pituitary patients, managed at the University of Colorado, from 2004 to 2019. The final analysis included 154 patients with prolactinomas, managed medically, and 120 patients, treated surgically. Primary outcome measures were percentage of tumor volume reduction and prolactin level (ng/mL). Mann–Whitney test was used for quantitative variables, contingency tables, and chi-square tests for qualitative variables. Statistical significance was set at p < 0.05.

Results DAs alone were more frequently used for microprolactinomas and Knosp grade 0 adenomas. Surgery was more often performed for macroprolactinomas, giant adenomas, tumors with suprasellar extension, mixed consistency, and sellar floor erosion. Among macroprolactinomas, mean tumor volume reduction after treatment with DAs alone, DAs and surgery, and surgery alone was 53.8, 94.9, and 94.1%, respectively. Prolactin levels after treatment were not significantly different. Continuous DA treatment was required in 94.3% patients in the medical group versus 39.6% in the surgical group.

Conclusions Surgery for macroprolactinomas achieved greater tumor volume reduction and dose reduction or discontinuation of DAs. Prolactin levels achieved did not differ significantly between the groups. Over 60% of patients, undergoing surgery, were able to discontinue DAs. The current treatment paradigm may underestimate the role of surgery in the management of prolactinomas.

简介 目前，泌乳素瘤的一线治疗方法是多巴胺激动剂 (DA)。医疗管理时间较长，并伴有副作用、经济和心理负担。在专门的中心，垂体手术是一种低风险的选择。我们评估了药物和手术治疗的结果指标，以评估手术的作用是否被低估。

方法 我们回顾了 2004 年至 2019 年科罗拉多大学治疗的 4,660 名垂体患者的图表。最终分析包括 154 名接受内科治疗的催乳素瘤患者和 120 名接受手术治疗的患者。主要结果指标是肿瘤体积减少的百分比和催乳素水平（ng/mL）。曼-惠特尼检验用于定量变量，列联表和卡方检验用于定性变量。统计显着性设定为p  < 0.05。

结果 单独使用 DA 更常用于治疗微小泌乳素瘤和 Knosp 0 级腺瘤。手术更常用于治疗催乳素大瘤、巨大腺瘤、鞍上扩展、混合稠度和鞍底糜烂的肿瘤。在泌乳素大瘤中，单独使用 DA、DA 联合手术以及单独手术治疗后的平均肿瘤体积缩小率分别为 53.8%、94.9% 和 94.1%。治疗后催乳素水平没有显着差异。医疗组中 94.3% 的患者需要持续 DA 治疗，而手术组中这一比例为 39.6%。

结论 泌乳素大腺瘤手术可实现更大的肿瘤体积缩小以及 DA 剂量的减少或停药。各组之间达到的催乳素水平没有显着差异。超过 60% 接受手术的患者能够停用 DA。目前的治疗模式可能低估了手术在泌乳素瘤治疗中的作用。