Five years follow-up of invasive prolactinomas with special reference to the control of cavernous sinus invasion

Wu, Zhe; Su, Zhi Peng; Wu, Jin Sen; Zheng, Wei; Zhuge, Qǐ Chuan; Ming, Zhong

doi:10.1007/s11102-007-0072-4

Cited by 31 publications

(29 citation statements)

References 43 publications

(64 reference statements)

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“…Previous studies have demonstrated that volume decrement on initial MRI or prolonged medication may result in further volume decrement, and our findings also supported these results [12,15,19]. In addition, our results suggest that tumor contrast enhancement profiles after medication may be another predictor of the radiologic response rate.…”

Section: Discussionsupporting

confidence: 90%

“…Even after patients had achieved radiologic remission, they had to receive DA to maintain normal endocrine function [12,13]. The causes of increased prolactin after radiologic remission are suggested as follows: 1) prolactin secretion from residual tumors in the cavernous sinus or other areas, despite their absence in the MR images; and 2) injury to the hypothalamic-pituitary-axis in the process of the empty sella formation [12]. Considering these findings, the prolactin normalization remains an important and easily assessable end-point.…”

Section: Discussionmentioning

confidence: 99%

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Bromocriptine Therapy for the Treatment of Invasive Prolactinoma: The Single Institute Experience

Park

Shin

2013

Brain Tumor Res Treat

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ObjectiveThe objective of this study was to describe and characterize the clinical course of treatment for invasive prolactinoma patients using bromocriptine.MethodsThe study group included 23 patients who were treated with bromocriptine for their invasive prolactinomas. Clinical histories, serum prolactin level and pituitary hormone assessments, tumor diameter and signal intensity on sella magnetic resonance imaging (MRI), visual field exams and the dosage of medications were reviewed for each patient.ResultsDuring 30 months (median, range 6-99) of follow-up period, 19 patients treated with bromocriptine alone achieved biochemical remission. Four patients changed the medication to cabergoline due to the adverse effects or observed resistance of bromocriptine treatment. All of five patients who had visual symptoms improved after the course of medication. Four surgically treated patients were not able to discontinue medication because they could not maintain biochemical remission state without medication. Multivariate analysis showed that decreased enhancement on the initial followed MRI after medication and longer follow-up periods were associated with higher radiologic response.ConclusionWe reassure that the dopamine agonist is safe and effective for the treatment of invasive pituitary adenomas. Meanwhile, surgery has a limited role on biochemical remission. Decreased enhancement on the initial follow-up MRI after medication may reflect the treatment response. Further study is required to validate the role of MRI or other factors on the actual prognosis.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Bromocriptine Therapy for the Treatment of Invasive Prolactinoma: The Single Institute Experience

Park

Shin

2013

Brain Tumor Res Treat

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“…The tumor diameter [16], or volume calculated by Tada formula [7,17] was considered as the main evaluation indicator for tumor size. However, tumor volume of pituitary adenoma calculated by Tada formula would generate great error because of the irregular shape and the multi-direction growth of pituitary adenoma.…”

Section: Discussionmentioning

confidence: 99%

Analysis of operative efficacy for giant pituitary adenoma

et al. 2014

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BackgroundSurgical treatment of giant pituitary adenomas is difficult due to complicated dissection of the sellar area. The extent of tumor resection affects the efficacy of surgical treatment. This study is to investigate the efficacy of microsurgical treatment for giant pituitary adenoma and to analyze the relationship between treatment efficacy and tumor resection extent.MethodsA retrospective analysis was performed in 36 patients who received microsurgery to remove giant pituitary adenomas. The sizes of tumors before and after surgery were calculated with a novel method called the “platform-like volume calculation formula”. The relationships between extent of resection and the visual impairment recovery, and improvement of serum hormone level before and after operation were analyzed.ResultsTwo deaths were observed after surgery. And the gross and near-total resection was achieved in 8 cases, subtotal resection in 8 cases, mostly partial resection in 15 cases, and partial resection in 5 cases. The average resection rate was 72.8%. The resection rate of tumor with cavernous sinus invasion was significantly lower than those of patients without cavernous sinus invasion (P < 0.05). The improvement rate of hormone level in functional adenoma was 80.0%. Follow-up observations were carried out for 3 ~ 28 months in 25 cases. Visual improvement was observed in 64.0% of the cases.ConclusionsMicrosurgical treatment can improve the visual impairment of the majority of cases and significantly decrease the serum hormone levels of functional adenoma. The extent of resection was significantly associated with cavernous sinus invasion.

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“…Residual cavernous sinus lesions in some patients may remain even after continuous drug therapy. 28,46,55,56 …”

Section: Discussionmentioning

confidence: 99%

Endoscopic endonasal transsphenoidal approach for pituitary adenomas invading the cavernous sinus

Ceylan¹,

Koç²,

Anık³

2010

JNS

126

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Compared with transcranial and microscopic transsphenoidal surgery, endoscopic transsphenoidal surgery offers a wide exposure for cavernous sinus medial wall adenomas that enables removal of the adenoma from the medial cavernous sinus wall. Because of the necessity for multidisciplinary treatment to achieve satisfactory results, Gamma Knife surgery and medical therapy should be supplementary treatment options after endoscopic transsphenoidal surgery.

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Five years follow-up of invasive prolactinomas with special reference to the control of cavernous sinus invasion

Cited by 31 publications

References 43 publications

Bromocriptine Therapy for the Treatment of Invasive Prolactinoma: The Single Institute Experience

Bromocriptine Therapy for the Treatment of Invasive Prolactinoma: The Single Institute Experience

Analysis of operative efficacy for giant pituitary adenoma

Endoscopic endonasal transsphenoidal approach for pituitary adenomas invading the cavernous sinus

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