Treatment of Prolactinoma in Knosp Grade 0 or 1 (Microprolactinoma or Well-Circumscribed Macroprolactinoma)
This protocol covers the first-line management of prolactinoma when the adenoma is classified as Knosp grade 0 or 1 — meaning it is either a microprolactinoma or a well-circumscribed macroprolactinoma with limited or no cavernous sinus invasion.
Clinical Scenario
In Knosp grade 0 and 1 prolactinoma, the tumour is anatomically favourable: small or well-contained, without significant lateral extension. Surgical resection by an experienced neurosurgeon offers a high chance of cure in this subgroup, and the curative potential together with the risks of each approach should be evaluated in a multidisciplinary setting before committing to a treatment path.
Treatment Approach
For this specific population, first-line management involves a structured discussion of surgical resection alongside medical therapy with a dopamine agonist — both options are considered appropriate starting points and are addressed together within the protocol.
The full regimen, selection criteria, and decision algorithm are available in the complete protocol.
Treatment Goal
The primary target is normalization of serum prolactin levels (normoprolactinaemia / surgical remission).
References
DOI: 10.1038/s41574-023-00886-5
- Surgical resection of microprolactinomas and well-circumscribed macroprolactinomas (Knosp grade 0 and 1) by an experienced neurosurgeon offers a high chance of cure, is cost-effective and avoids long-term dopamine agonist treatment.
- For microprolactinomas and well-encased macroprolactinomas (Knosp grade 0 and 1), the curative potential and risks of surgery should be discussed with patients in a multidisciplinary setting prior to medical treatment initiation (strong).
- Surgery by an expert pituitary neurosurgeon should therefore be discussed alongside dopamine agonist treatment as a first-line option in this subgroup of patients (strong).
- Cabergoline is the preferred dopamine agonist owing to its long half-life, high efficacy and good tolerability (strong).
- Transsphenoidal surgery (TSS) performed by an experienced neurosurgeon can achieve initial normoprolactinaemia in up to 93% of individuals with microprolactinomas and 75% of those with selected macroprolactinomas.
View source ↗