SEE YOUR ENDOCRINOLOGIST FOR A PITUITARY TUMOUR; YOU MAY NOT NEED SURGERY

Abstract This brief review emphasizes the importance of proper diagnosis prior to management of patients with pituitary lesions. Surgery remains the treatment of choice for many pituitary adenomas but not all of them require surgery. Lactotroph adenomas secreting excessive amount of prolactin (often termed as Prolactinomas) are usually responsive to pharmacological treatment with dopamine receptor (D2) agonists and should not be treated surgically except in a selected group of patients.  Surgery is no longer the first line treatment for prolactinomas.  All those patients of prolactinomas who may be considered for surgery must be discussed in an MDT (multi-disciplinary team) meeting prior to surgical intervention. In clinical practice in Pakistan one comes across a noticeable number of patients of lactotroph adenomas referred after surgical resection performed as a primary treatment for their pituitary adenomas. Most of these patients were referred to Endocrinology department following recurrence of prolactinomas and further surgical resection could not be performed.  There is no local data of those prolactinomas which may have been cured after surgery. The comparison between surgical and pharmacological treatment is not possible in local population but worldwide data available in literature clearly suggests that surgery should no longer be the first line treatment in majority of patients with prolactinomas. Pharmacological treatment is convenient, more effective and longer lasting compared to surgical treatment. Keywords Pituitary gland, micro prolactinomas, macro prolactinomas, lactograph, dopamine receptor agonist