Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China.
Department of Neurosurgery, Huashan Hospital Fudan University, No. 12 Wulumuqi Middle Road, Jing'an District, Shanghai, 200040, China.
Endocrine. 2018 Oct;62(1):76-82. doi: 10.1007/s12020-018-1652-y. Epub 2018 Jun 22.
Prolactinoma is the most common subtype of functional pituitary adenoma. Effective therapy is required for women of child-bearing age to achieve remission at serum prolactin level and regain reproductive function.
To evaluate long-term outcomes, including menstrual recovery, after transsphenoidal surgery on female prolactinoma patients by experienced neurosurgeons.
Observational study.
Consecutive female prolactinoma patients aged from 16 to 45 years were included. Histological analysis after surgery revealed adenoma with positive staining for prolactin. Plurihormonal cell adenomas were excluded.
Clinical manifestations, surgical indications, serum prolactin level before and after surgery, surgical complications, pituitary fuctions, drug maintenance, the status of menstruation, and pregnancy.
Sixty-three consecutive female patients with a mean age of 29.5 ± 1.1 years were included. Based on magnetic resonance imaging findings before surgery, 31 (49.2%) patients had microadenoma, and the remaining 32 (50.8%) had macroadenoma. The median follow-up after transsphenoidal surgery was 53 (33-74) months, and long-term surgical remission was achieved in 50 (79.37%) patients with 28 (90.32%) microadenomas and 22 (68.75%) macroadenomas. No meningitis or persistent cerebrospinal fluid leaks occurred. Only one case suffered from persistent diabetes insipidus at follow-up. No severe pituitary dysfunction was observed in microprolactinoma patients. Of patients with menstrual disorders, 85% regained regular menstrual cycles after surgery. Nineteen patients in this cohort desired pregnancy and 15 of them successfully gave birth after surgery. All 17 microadenoma patients with modern surgical indications achieved normal prolactin levels and regular menstrual cycles with only one patient on drug therapy at follow-up.
Long-term follow-up showed a high remission rate in female prolactinoma patients, especially in microadenoma patients, after surgery. Transsphenoidal surgery performed by experienced neurosurgeons may offer a valuable approach to treat female microprolactinoma patients of child-bearing age with modern indications for surgery.
催乳素腺瘤是最常见的功能性垂体腺瘤亚型。对于育龄期妇女，需要有效的治疗以达到血清催乳素水平缓解，并恢复生殖功能。
评估经验丰富的神经外科医生对女性催乳素腺瘤患者进行经蝶窦手术的长期结果，包括月经恢复情况。
观察性研究。
纳入年龄在 16 至 45 岁之间的连续女性催乳素腺瘤患者。术后组织学分析显示催乳素阳性染色的腺瘤。排除多激素细胞腺瘤。
临床表现、手术指征、术前和术后血清催乳素水平、手术并发症、垂体功能、药物维持、月经状况和妊娠情况。
纳入了 63 例连续的女性患者，平均年龄为 29.5±1.1 岁。根据术前磁共振成像结果，31 例（49.2%）患者为微腺瘤，其余 32 例（50.8%）为大腺瘤。经蝶窦手术后的中位随访时间为 53（33-74）个月，50 例（79.37%）患者达到长期手术缓解，其中 28 例（90.32%）微腺瘤和 22 例（68.75%）大腺瘤。无脑膜炎或持续性脑脊液漏发生。仅 1 例患者在随访时患有持续性尿崩症。微催乳素腺瘤患者无严重垂体功能障碍。在月经失调的患者中，85%在手术后恢复了正常的月经周期。该队列中有 19 名患者希望怀孕，其中 15 名在手术后成功生育。所有 17 名具有现代手术指征的微腺瘤患者，在随访时仅 1 例患者需要药物治疗，均达到了正常的催乳素水平和正常的月经周期。
长期随访显示，女性催乳素腺瘤患者，尤其是微腺瘤患者，手术后缓解率较高。经验丰富的神经外科医生进行的经蝶窦手术可能为具有现代手术指征的育龄期女性微催乳素腺瘤患者提供一种有价值的治疗方法。
