Surgical versus medical treatment in improving visual outcomes in adult patients with giant pituitary prolactinomas

Abstract

Prolactinomas are the most common pituitary tumors in adults, accounting for up to of pituitary tumors. Microprolactinomas are more common in women, whereas macroprolactinomas are more frequent in men, giant prolactinomas are an unusual subset of macroprolactinomas and are more commonly found in men ; . There is no consensus on the definition of a giant prolactinoma ; . Therefore, we propose that giant prolactinoma should be defined as an adenoma with a maximum diameter of more than cm, that is associated with serum PRL above ng/ml ; . In most patients, there is an association between serum PRL level and tumor volume. Therefore, patients with giant prolactinomas often have very high serum PRL. However, this association is not always consistent, and tumor mass and PRL level may be dissociated. The hook effect is a possible cause for this discrepancy and has been reported to occur in of giant prolactinomas . Cystic giant prolactinomas are another potential cause of that discrepancy between PRL level and tumor volume because the number of viable lactotrophs is not excessively high due to cystic degeneration. Introduc