Schlechte J A, Sherman B M, Chapler F K, VanGilder J
J Clin Endocrinol Metab. 1986 Jun;62(6):1296-301. doi: 10.1210/jcem-62-6-1296.
To examine the long term effectiveness of transsphenoidal microsurgery for patients with PRL-secreting pituitary tumors, we studied 54 women at yearly intervals after transsphenoidal surgery. Five years after surgery, 19 women (35%) had normal serum PRL concentrations, and 23 (43%) had persistent hyperprolactinemia. Hyperprolactinemia recurred in 12 of 31 patients (39%) who had normal PRL concentration 6 weeks after surgery. None of the patients with recurrent hyperprolactinemia had radiographic evidence of tumor regrowth, and only 3 of 12 had amenorrhea. A serum PRL level below 6 ng/ml 6 weeks after surgery occurred more frequently in cured patients than in those who had a recurrence. PRL responses to TRH were normal in cured patients 1 and 5 yr after surgery and abnormal in those who had recurrent hyperprolactinemia. The PRL responses to chlorpromazine- and insulin-induced hypoglycemia were blunted in patients with normal as well as elevated PRL levels. Patients with recurrent, as well as those with persistent, hyperprolactinemia had no nocturnal rise in serum PRL 5 yr after surgery. The 39% recurrence rate of hyperprolactinemia and persistent abnormalities in pituitary-hypothalamic regulation of PRL secretion after transsphenoidal surgery raise important questions about the choice of primary therapy for patients with PRL-secreting tumors.
为了研究经蝶窦显微手术治疗泌乳素分泌型垂体瘤患者的长期疗效，我们在经蝶窦手术后每年对54名女性进行随访研究。术后5年，19名女性（35%）血清泌乳素浓度正常，23名（43%）持续高泌乳素血症。术后6周泌乳素浓度正常的31名患者中，12名（39%）出现高泌乳素血症复发。复发高泌乳素血症的患者均无肿瘤复发的影像学证据，12名中只有3名出现闭经。术后6周血清泌乳素水平低于6 ng/ml的情况在治愈患者中比复发患者更常见。术后1年和5年，治愈患者对促甲状腺激素释放激素（TRH）的泌乳素反应正常，而复发高泌乳素血症的患者则异常。泌乳素水平正常及升高的患者对氯丙嗪和胰岛素诱导的低血糖的泌乳素反应均减弱。复发及持续高泌乳素血症的患者术后5年血清泌乳素均无夜间升高。经蝶窦手术后高泌乳素血症39%的复发率以及泌乳素分泌的垂体 - 下丘脑调节持续异常，引发了关于泌乳素分泌型肿瘤患者初始治疗选择的重要问题。
