Shimon Ilan, Sosa Ernesto, Mendoza Victoria, Greenman Yona, Tirosh Amit, Espinosa Etual, Popovic Vera, Glezer Andrea, Bronstein Marcello D, Mercado Moises
Institute of Endocrinology, Beilinson Hospital, Rabin Medical Center, 49100, Petah Tikva, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Pituitary. 2016 Aug;19(4):429-36. doi: 10.1007/s11102-016-0723-4.
Prolactin (PRL)-secreting macroadenomas usually measure between 10 and 40 mm. Giant (adenoma size ≥40 mm) PRL-tumors are not common, and larger prolactinomas (maximal diameter ≥60 mm) are rare, and their management outcomes have not been well characterized.
We have identified 18 subjects (16 men, 2 females) with giant PRL-adenomas (size ≥60 mm; PRL > 1000 ng/ml) and summarized their characteristics and response to treatment.
Mean age was 36.3 ± 13.5 years (range 12-59 years). Mean adenoma size was 71.8 ± 10.2 mm (60-92 mm). Complaints at presentation included headaches in 11 patients, visual deterioration in 9, sexual dysfunction in 9 males, and behavioral changes in two. Fourteen (78 %) had visual field defects. Mean PRL at presentation was 28,465 ng/ml (range 1300-270,000). All patients were treated with cabergoline (3.9 ± 2.0 mg/week), except for one who received bromocriptine. Treatment achieved PRL normalization in 11/18 patients within a median interval of 20 months. Visual improvement occurred in 12/14 patients with pre-treatment visual abnormalities. Nine patients underwent surgery (transsphenoidal, 7; transcranial, 2). None of the seven patients with elevated PRL before surgery achieved remission post-operatively. After a follow-up of 7.8 ± 5.1 years, 15/18 patients had significant adenoma shrinkage. Eleven patients are normoprolactinemic, 3 are partially controlled (PRL < 3 × ULN), and 4 remain with significantly elevated PRL. Most patients reported disappearance or improvement of their complaints.
These enormous PRL-adenomas are invasive but respond fairly well to medical treatment. Long-term therapy with high dose cabergoline together with a pituitary surgery in some patients was the key for their successful management, achieving biochemical and clinical remission in most patients.
分泌催乳素（PRL）的大腺瘤通常直径在10至40毫米之间。巨大型（腺瘤大小≥40毫米）PRL肿瘤并不常见，而更大的催乳素瘤（最大直径≥60毫米）则很罕见，其治疗结果尚未得到充分描述。
我们确定了18例患有巨大型PRL腺瘤（大小≥60毫米；PRL>1000纳克/毫升）的患者（16例男性，2例女性），并总结了他们的特征及治疗反应。
平均年龄为36.3±13.5岁（范围12至59岁）。腺瘤平均大小为71.8±10.2毫米（60至92毫米）。就诊时的主诉包括11例患者头痛，9例视力减退，9例男性性功能障碍，2例行为改变。14例（78%）有视野缺损。就诊时PRL平均水平为28465纳克/毫升（范围1300至270000）。除1例接受溴隐亭治疗外，所有患者均接受卡麦角林治疗（3.9±2.0毫克/周）。11/18例患者在中位间隔20个月内PRL恢复正常。12/14例治疗前有视力异常的患者视力得到改善。9例患者接受了手术（经蝶窦手术7例；经颅手术2例）。术前PRL升高的7例患者术后均未缓解。随访7.8±5.1年后，15/18例患者腺瘤明显缩小。11例患者PRL正常，3例部分得到控制（PRL<3×ULN），4例PRL仍显著升高。大多数患者报告其主诉消失或改善。
这些巨大的PRL腺瘤具有侵袭性，但对药物治疗反应相当良好。高剂量卡麦角林长期治疗并在部分患者中联合垂体手术是成功管理这些腺瘤的关键，使大多数患者实现了生化和临床缓解。
