Transsphenoidal microsurgery for pituitary tumors associated with hyperprolactinemia

Abstract

The results of transsphenoidal microsurgery in treating 37 patients (30 women and seven men) with pituitary tumors associated with hyperprolactinemia are presented. Immediate (10-day) postoperative fasting prolactin levels were normal (less than 25 ng/ml) in 19 of 26 patients whose preoperative prolactin level was less than 200 ng/ml, and in only three of 11 patients in whom preoperative prolactin was greater than 200 ng/ml. Twelve of 13 patients with normal preoperative pituitary-target organ function maintained normal axes postoperatively. Thirteen other patients had preoperative deficiencies in one or more pituitary-target organ axes. Postoperatively, in these latter 13 patients, a pituitary-target organ axis that was deficient preoperatively returned to normal in six cases; there was no change in five, and there was impairment in another axis in four instances. Although gross total tumor removal was believed to be complete in 35 of 37 patients, serial postoperative prolactin determinations in four of these 35 patients indicate tumor regrowth. The authors conclude that transsphenoidal microsurgery is currently the operative procedure of choice for the majority of pituitary tumors associated with hyperprolactinemia.

Pituitary microadenomas: Surgical results and morphological findings

“…Similar results have been obtained by other authors 1-8, la, 14, 18,22,23 The only case of a partially empty sella due to spontaneous infarction in our case histories merits the following considerations: first of all, the preoperative diagnosis is difficult in such cases, although the natural history of microadenomas is still uncertain and spontaneous infarction or resolution may occur; at present there is no means available for predicting the ultimate biological behaviour of these tumours. Secondly, the surgical removal of endosellar fluid followed by medical therapy with small doses of dopaminergic drugs, which was ineffective before the operation, brought about the normalization of the levels of hPRL.…”

Prolactinomas and Optic Nerve Compression: Disappearance of a Suprasellar Extension and Visual Recovery after Two Weeks Bromocriptine Treatment

“…Urgent transfrontal decompression is generally regarded as the treat ment of choice when vision is threatened [1], In skilled hands, the trans sphenoidal approach is superior: tumour removal and visual recovery can be accomplished preserving pituitary function with an operation that carries a far lower morbidity and mortality [3]. Nevertheless, in patients presenting with serum prolactin levels above 200 ng/ml, tumour removal is frequently incomplete and symptomatic hyperprolactinaemia persists postoperatively [2.…”

“…When vision is threatened, surgery via the transfrontal approach is generally advocated [1] but the tumour can never be totally removed. In some centres the transsphenoidal route is used [2][3][4] and in a recent report visual improvement was achieved in 5 out of 9 patients [3]. Although microadenomas can be totally removed by transsphenoidal surgery in up to 90% of cases [5,6].…”

Abnormal Dopamine Sensitivity in Some Human Prolactinomas

“…Al though both surgery [1] and dopamine agonist drugs [2] have been successful in the management of such cases, a minority of patients are not cured by such therapeutic approaches. Consequently, research into the pathogene sis of the prolactinoma remains justified.…”