Department of Internal Medicine, Institute of Endocrinology, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul 120-752, Korea.
Endocrine. 2010 Feb;37(1):140-7. doi: 10.1007/s12020-009-9279-7. Epub 2009 Nov 14.
The objective of this study was to evaluate characteristics that discriminate prolactinoma from non-functioning pituitary macroadenoma with hyperprolactinemia. We included 117 patients with hyperprolactinemic pituitary macroadenomas. Patients were divided into three groups according to treatment outcomes and pathologic results: (A) prolactinoma that responded to dopamine agonist (DA) treatment (PRDA); (B) prolactinoma requiring surgical treatment (PRS); and (C) non-functioning pituitary adenoma with hyperprolactinemia (NFPAH). Old age, low serum prolactin levels, and extrasellar extension were associated with NFPAH. Most patients with NFPAH had serum prolactin levels less than 100 ng/ml. Visual defects and GH deficiency were more common in patients with NFPAH compared with patients with PRS and PRDA, without difference of tumor size. Galactorrhea and amenorrhea were less frequent in patients with NFPAH than in patients with PRS and PRDA. Post-operative remission of hyperprolactinemia was achieved in 100% of patients with NFPAH and in 72.5% of patients with PRS. DA administration was required in 25.5% of patients with PRS; however, no patients with NFPAH required DA administration. In conclusion, old age, extrasellar tumor extension with relatively low prolactin levels, visual defect, and GH deficiency were considered suggestive of non-functioning pituitary adenoma rather than prolactinoma in hyperprolactinemic pituitary macroadenoma.
本研究旨在评估具有高泌乳素血症的泌乳素瘤与无功能垂体大腺瘤之间的鉴别特征。我们纳入了 117 例高泌乳素血症性垂体大腺瘤患者。根据治疗效果和病理结果将患者分为三组：（A）对多巴胺激动剂（DA）治疗有反应的泌乳素瘤（PRDA）；（B）需要手术治疗的泌乳素瘤（PRS）；和（C）伴有高泌乳素血症的无功能垂体腺瘤（NFPAH）。高龄、低血清泌乳素水平和鞍外扩展与 NFPAH 相关。大多数 NFPAH 患者的血清泌乳素水平低于 100ng/ml。与 PRS 和 PRDA 患者相比，NFPAH 患者更常见视觉缺陷和 GH 缺乏，而肿瘤大小无差异。与 PRS 和 PRDA 患者相比，NFPAH 患者的溢乳和闭经较少。NFPAH 患者的高泌乳素血症术后缓解率为 100%，PRS 患者为 72.5%。PRS 患者中有 25.5%需要 DA 治疗；然而，NFPAH 患者中无一例需要 DA 治疗。总之，高龄、具有相对较低泌乳素水平的鞍外肿瘤扩展、视觉缺陷和 GH 缺乏提示为无功能垂体腺瘤，而不是高泌乳素血症性垂体大腺瘤中的泌乳素瘤。
