巨大男性泌乳素瘤的神经、精神、眼科和内分泌并发症：阿尔及利亚人群的一项观察性研究。
Neurological, psychiatric, ophthalmological, and endocrine complications in giant male prolactinomas: An observational study in Algerian population.
作者信息
Chentli Farida, Azzoug Said, Daffeur Katia, Akkache Lina, Zellagui Hadjer, Haddad Meriem, Kalafate Nadia
机构信息
Department of Endocrine and Metabolic Diseases, Bab El Oued Teaching Hospital, University of Medicine, Algiers, Algeria.
出版信息
Indian J Endocrinol Metab. 2015 May-Jun;19(3):359-63. doi: 10.4103/2230-8210.152771.
INTRODUCTION
Prolactinomas are less frequent, but more invasive in males. Giant ones (≥4 cm) are extremely rare in literature. Their neurological, psychiatric and endocrine complications are life threatening. Our aim was to report the largest mono center series in order to analyze their frequency, their characteristics, and their complications.
SUBJECTS AND METHODS
All patients had clinical examination, hormonal, ophthalmological, and radiological assessment based on computed tomography scan and cerebral magnetic resonance imaging. Positive diagnosis was based on clinical symptoms, high prolactin ± immunohistochemy study. Mixed adenomas were excluded by hormonal exploration and immunohistochemy. For those who received medical treatment only, a reduction in tumor size was considered a supplementary positive point for the diagnosis.
RESULTS
Among 154 male prolactinomas seen between 1987 and 2013, we observed 44 giant tumors (28.5%). Median age = 36 years, and 38.3% were under 30. Median tumor height = 53.95 mm (40-130) and median prolactin = 15,715 ng/ml (n < 20). Solid and cystic aspect ± calcifications was observed in 25%. 42 had cavernous sinuses invasion. Other invasions were: Posterior= 65.9%, anterior= 63.6%, temporal= 15.9% and frontal = 9%. For endocrine complications: Hypogonadism = 98.4%, thyrotroph and corticotroph deficits were seen in respectively 34%, and 32%. Posterior pituitary insufficiency was observed in one case. For ophthalmological complications: Optic atrophy = 46%, Ptosis = 6.8%, diplopia/strabismus = 4.5%. Neurological complications were: Memory loss and/or unconsciousness = 18.2%, epilepsy = 15.9%, frontal syndrome = 9% and obstructive hydrocephalus = 6.8%.
CONCLUSION
Giant prolactinomas account for 28% in our population. Severe neurological complications are frequent. But, obstructive hydrocephalus is rare, which argues for a slow progression.
引言
泌乳素瘤在男性中较为少见，但侵袭性更强。巨大泌乳素瘤（≥4厘米）在文献中极为罕见。其神经、精神及内分泌并发症会危及生命。我们的目的是报告最大的单中心系列病例，以分析其发生率、特征及并发症。
研究对象与方法
所有患者均接受了临床检查、激素检查、眼科检查以及基于计算机断层扫描和脑磁共振成像的放射学评估。阳性诊断基于临床症状、高泌乳素水平±免疫组化研究。通过激素检测和免疫组化排除混合性腺瘤。对于仅接受药物治疗的患者，肿瘤大小缩小被视为诊断的补充阳性指标。
结果
在1987年至2013年间诊治的154例男性泌乳素瘤患者中，我们观察到44例巨大肿瘤（28.5%）。中位年龄为36岁，38.3%的患者年龄在30岁以下。中位肿瘤高度为53.95毫米（40 - 130），中位泌乳素水平为15,715纳克/毫升（n < 20）。25%的肿瘤表现为实性和囊性外观±钙化。42例患者出现海绵窦侵袭。其他侵袭情况为：后方侵袭占65.9%，前方侵袭占63.6%，颞叶侵袭占15.9%，额叶侵袭占9%。内分泌并发症方面：性腺功能减退占98.4%，促甲状腺激素和促肾上腺皮质激素缺乏分别占34%和32%。有1例患者出现垂体后叶功能不全。眼科并发症方面：视神经萎缩占46%，上睑下垂占6.8%，复视/斜视占4.5%。神经并发症包括：记忆力减退和/或意识丧失占18.2%，癫痫占15.9%，额叶综合征占9%，梗阻性脑积水占6.8%。
结论
巨大泌乳素瘤在我们的研究人群中占28%。严重的神经并发症很常见。但是，梗阻性脑积水罕见，这表明肿瘤进展缓慢。
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