Vale Fernando L, Deukmedjian Armen R, Hann Shan, Shah Vitra, Morrison Anthony D
Department of Neurological Surgery & Brain Repair, University of South Florida, Tampa, FL 33606, USA.
Br J Neurosurg. 2013 Feb;27(1):56-62. doi: 10.3109/02688697.2012.714817. Epub 2012 Aug 31.
The incidence of medical failure for prolactin (PRL)-secreting pituitary tumours is not well known. Object. The purpose of this study is to report clinical, radiographic and laboratory findings of PRL-secreting tumours that predict failed medical management.
An analysis of 92 consecutive patients was performed that met the inclusion criteria. Decision for surgery was made based on failure of dopamine agonists to either control clinical symptoms and normalise hormonal level or diminish mass effect on follow-up evaluation.
Of the 92 patients treated, 14 patients (15%) required trans-nasal, trans-sphenoidal pituitary surgery (TSS). One patient underwent surgery for repair of a skull defect and 13 patients (14%) required surgery after failed medical management. Higher initial PRL was statistically significant regarding the need for surgical intervention, but a persistently abnormal level after initiation of treatment was a more significant predictor (Fisher exact test, p = 0.005 vs. p < 0.001). Size was also a statistically significant factor (p = 0.014); macroadenomas had a relative risk of 9.27 (95% CI: 1.15-74.86) for needing surgery compared to microadenomas. In addition, macroadenomas with cavernous sinus (CS) extension and pre-operative visual field deficit demonstrated a strong tendency for surgical intervention.
Medical management remains the most effective treatment option for prolactinomas. A partial hormonal response to medical management seems to be the most significant predictive factor but adenomas > 20 mm, visual field deficit and invasion of the CS may help predict the need for surgery. We suggest a minimum trial period (at least 8 weeks) of medical treatment prior to the consideration of surgery.
分泌催乳素（PRL）的垂体瘤的药物治疗失败率尚不清楚。目的：本研究旨在报告分泌PRL肿瘤的临床、影像学和实验室检查结果，以预测药物治疗失败情况。
对92例符合纳入标准的连续患者进行分析。根据多巴胺激动剂未能控制临床症状、使激素水平恢复正常或在随访评估中减轻肿块效应来决定是否进行手术。
在接受治疗的92例患者中，14例（15%）需要经鼻蝶窦垂体手术（TSS）。1例患者因颅骨缺损修复接受手术，13例（14%）在药物治疗失败后需要手术。就手术干预的必要性而言，初始PRL水平较高具有统计学意义，但治疗开始后持续异常的水平是更显著的预测因素（Fisher精确检验，p = 0.005对比p < 0.001）。肿瘤大小也是一个具有统计学意义的因素（p = 0.014）；与微腺瘤相比，大腺瘤需要手术的相对风险为9.27（95% CI：1.15 - 74.86）。此外，侵犯海绵窦（CS）且术前有视野缺损的大腺瘤显示出强烈的手术干预倾向。
药物治疗仍然是催乳素瘤最有效的治疗选择。药物治疗的部分激素反应似乎是最显著的预测因素，但直径> 20 mm的腺瘤、视野缺损和CS侵犯可能有助于预测手术需求。我们建议在考虑手术前进行至少8周的药物治疗最短试验期。
