Acquati S, Pizzocaro A, Tomei G, Giovanelli M, Libè R, Faglia G, Ambrosi B
Institute of Endocrine Sciences, University of Milan, Italy.
J Neurosurg Sci. 2001 Jun;45(2):65-9.
The surgical success rate in macroprolactinomas is quite low, while medical treatment is more effective in reducing PRL levels and tumour mass. In this study the effectiveness of surgical, medical and radiant approaches on clinical symptoms, PRL levels and tumour size were compared in a large series of patients with macroprolactinomas.
One hundred and thirty-two patients (63 males and 69 females) were followed-up. Eighty-three patients were operated by trans-sphenoidal (TSS) approach: 18 underwent only TSS, 10 were operated and then irradiated; 30 patients underwent TSS and dopamine agonists, 25 were treated by TSS, radiotherapy and dopamine agonists. One hundred and four patients were treated by medical therapy: 49 patients were only administered dopamine agonists and 55 were given dopamine agonists after unsuccessful surgery and/or radiotherapy.
In 83 patients serum PRL levels decreased from 1873+/-319.9 ng/ml to 831.6+/-297.8 ng/ml after trans-sphenoidal surgery: a significant PRL reduction was obtained in 18 cases (22%) and a full PRL normalization was found in 15 patients (18%). The pituitary adenoma was completely removed in the 15 cases, in whom serum PRL normalized. Sexual function was restored in 57 percent; of women and in 29 percent; of men. In contrast, dopaminergic drugs normalized PRL levels (from 1590.5+/-232.7 to 19.2+/-4.8 ng/ml) in 93/104 patients (89 percent;). Sexual function was restored in 74 percent; of women and in 75 percent; of men. Radiotherapy, performed after unsuccessful TSS, was ineffective in normalizing PRL levels.
Medical therapy should be considered the first choice treatment in macroprolactinomas, while the surgical approach is recommended when neurological compressive symptoms are present and in patients resistant or intolerant to dopamine agonists. Radiotherapy may be indicated only in the patients in whom medical and surgical therapy have not been successful.
大泌乳素瘤的手术成功率相当低，而药物治疗在降低泌乳素（PRL）水平和肿瘤体积方面更有效。在本研究中，对大量大泌乳素瘤患者比较了手术、药物和放射治疗方法对临床症状、PRL水平和肿瘤大小的疗效。
对132例患者（63例男性和69例女性）进行随访。83例患者采用经蝶窦（TSS）手术：18例仅接受TSS手术，10例手术后接受放疗；30例患者接受TSS手术和多巴胺激动剂治疗，25例患者接受TSS手术、放疗和多巴胺激动剂治疗。104例患者接受药物治疗：49例患者仅给予多巴胺激动剂，55例患者在手术和/或放疗失败后给予多巴胺激动剂。
83例患者经蝶窦手术后血清PRL水平从1873±319.9 ng/ml降至831.6±297.8 ng/ml：18例（22%）患者PRL显著降低，15例（18%）患者PRL完全恢复正常。15例PRL恢复正常的患者垂体腺瘤完全切除。57%的女性和29%的男性性功能恢复。相比之下，93/104例（89%）患者使用多巴胺能药物后PRL水平恢复正常（从1590.5±232.7降至19.2±4.8 ng/ml）。74%的女性和75%的男性性功能恢复。TSS手术失败后进行的放疗对PRL水平恢复正常无效。
药物治疗应被视为大泌乳素瘤的首选治疗方法，而当出现神经压迫症状以及患者对多巴胺激动剂耐药或不耐受时，建议采用手术治疗。仅在药物和手术治疗均未成功的患者中可考虑放疗。
