Prabhu Santosh, Prabhu Sujata
Department of Neurosurgery, Western India Institute of Neurosciences, Kolhapur, Maharashtra, India.
Department of Neuroanesthesia, Western India Institute of Neurosciences, Kolhapur, Maharashtra, India.
Asian J Neurosurg. 2019 Jul-Sep;14(3):754-758. doi: 10.4103/ajns.AJNS_127_19.
Pituitary adenomas, macro and micro, are a common occurrence in most neurosurgical centers. Prolactinomas are the most common pituitary tumors and are often treated nowadays with dopamine agonists such as cabergoline, with good results.
To suggest new therapeutic guidelines for treating Prolactinomas with Amyloid deposits on preoperative detection of Amyloid deposition in Pituitary tumors, based on MRI characteristics.
We report a case of a pituitary prolactinoma with amyloid deposits in a 45-year-old male who underwent a transsphenoidal excision of the adenoma. Although on magnetic resonance imaging scans, no amyloid was reported, at histopathology, spherical amyloid within the pituitary tumor was found in abundance. The patient underwent surgery without any trial of cabergoline due to rapid deterioration of vision.
Prolactinomas with amyloid deposits are known not to respond to dopamine agonists (cabergoline) by a reduction in size and may ,in fact increase in volume. Therefore, we recommend that in prolactinomas not responding to medical therapy, deposition of amyloid has to be considered as a cause for failure of medical therapy and surgery and then has to be offered pronto.
垂体腺瘤，无论大小，在大多数神经外科中心都很常见。泌乳素瘤是最常见的垂体肿瘤，如今通常用卡麦角林等多巴胺激动剂进行治疗，效果良好。
基于MRI特征，针对术前检测到垂体肿瘤中有淀粉样沉积的泌乳素瘤，提出新的治疗指南。
我们报告了一例45岁男性垂体泌乳素瘤合并淀粉样沉积的病例，该患者接受了经蝶窦腺瘤切除术。尽管磁共振成像扫描未报告有淀粉样物质，但在组织病理学检查中，发现垂体肿瘤内有大量球形淀粉样物质。由于视力迅速恶化，患者未尝试使用卡麦角林就接受了手术。
已知合并淀粉样沉积的泌乳素瘤对多巴胺激动剂（卡麦角林）无缩小肿瘤大小的反应，实际上肿瘤体积可能会增大。因此，我们建议，对于药物治疗无效的泌乳素瘤，必须考虑淀粉样沉积是药物治疗和手术失败的原因，然后应立即进行手术。
