Witek Przemysław, Zieliński Grzegorz, Maksymowicz Maria, Zgliczyński Wojciech
Department of Endocrinology and Isotope Therapy, Military Institute of Medicine, Warsaw, Poland.
Neuro Endocrinol Lett. 2012;33(5):483-8.
Prolactinoma is the most common secreting pituitary adenoma. It is typically diagnosed in women of reproductive age and is common cause of infertility. Currently the treatment of choice is pharmacotherapy with dopamine agonists, whereas surgical treatment is reserved for a selected group of patients. Pituitary-tumor apoplexy is a rare, life-threatening condition associated with significant morbidity and mortality. The authors present the case of a 25-year-old woman with prolactinoma treated with dopamine agonist. In course of such a treatment the patient became pregnant. The bromocriptine was gradually withdrawn. In the 14th week of pregnancy she was admitted for symptoms suggesting pituitary tumor apoplexy. The treatment with bromocriptine was reinitiated. In the 20th week of pregnancy further deterioration of the patient's neurological condition and visual-field abnormalities were observed. The patient was qualified for surgical treatment - selective transsphenoidal adenomectomy. The successful surgery led to improvement of neurological condition. The early postoperative PRL level decreased significantly and hormonal function of the pituitary was preserved. The pregnancy ended in 38th week with a caesarean section. Endocrinological evaluation conducted after the uneventful delivery confirmed normal function of the pituitary. Magnetic resonance imaging (MRI) did not reveal tumor re-growth. The patient is kept under constant medical care. In this case study the authors discussed therapeutic management and reviewed literature regarding gestational pituitary-tumor apoplexy with particular emphasis on surgical treatment.
泌乳素瘤是最常见的分泌性垂体腺瘤。它通常在育龄女性中被诊断出来，是导致不孕的常见原因。目前，首选的治疗方法是使用多巴胺激动剂进行药物治疗，而手术治疗则适用于特定的患者群体。垂体瘤卒中是一种罕见的、危及生命的疾病，具有较高的发病率和死亡率。作者介绍了一名25岁患有泌乳素瘤的女性患者，该患者接受了多巴胺激动剂治疗。在治疗过程中，患者怀孕了。溴隐亭逐渐停药。在怀孕第14周时，她因出现提示垂体瘤卒中的症状而入院。重新开始使用溴隐亭治疗。在怀孕第20周时，观察到患者的神经状况进一步恶化，视野出现异常。患者符合手术治疗条件——选择性经蝶窦腺瘤切除术。成功的手术使神经状况得到改善。术后早期泌乳素水平显著下降，垂体的激素功能得以保留。怀孕在第38周时通过剖宫产结束。顺利分娩后进行的内分泌评估证实垂体功能正常。磁共振成像（MRI）未显示肿瘤复发。患者一直在持续的医疗护理之下。在本病例研究中，作者讨论了治疗管理，并回顾了关于妊娠期垂体瘤卒中的文献，特别强调了手术治疗。
