Amano Kosaku, Oda Yuichi, Seki Yasufumi, Yamashita Kaoru, Bokuda Kanako, Ichihara Atsuhiro, Kawamata Takakazu
Department of Neurosurgery, Tokyo Women's Medical University.
Department of Endocrinology and Hypertension, Tokyo Women's Medical University.
Neurol Med Chir (Tokyo). 2024 Apr 15;64(4):160-167. doi: 10.2176/jns-nmc.2023-0184. Epub 2024 Feb 15.
Prolactin-producing pituitary tumor (PRLoma) is the most prevalent functional pituitary tumor. If the tumor becomes large, vision can be impaired. In contrast to other pituitary tumors, cabergoline (CAB) is extremely effective for PRLoma and has become the first-line treatment. In this study, we examined our experience with the pharmacological and surgical management of PRLomas with visual impairment (VI) to determine whether VI could be a surgical indication. Further, we discussed the function of surgery in situations where the gold standard of PRLoma treatment was CAB administration. Of the 159 patients with PRLomas (age, 13-77 [mean = 36.3] years; men, 29; women, 130) at Tokyo Women's Medical University Hospital from 2009 to 2021, 18 (age, 15-67 [mean = 35.8] years; men, 12; woman, 6) had VI (subjectively, 12; objectively, 6). They started CAB treatment immediately (maximum dose: 0.5 to 6 mg/week; average: 2.17 mg/week). VI improved in 16 patients (88.9%) but did not improve in 2 (11.1%) requiring surgeries. One of the two patients had a parenchymal tumor resistant to CAB, and the other had a cystic tumor due to intratumoral bleeding. Consequently, CAB is the first-line treatment for PRLomas with VI because of its significantly high rate of improvement. However, close and rigorous surveillance is necessary for cases resistant to CAB, and the correct decision is required regarding surgical interventions at proper timing and appropriate surgical approaches considering the purpose of surgery.
催乳素分泌型垂体瘤（泌乳素瘤）是最常见的功能性垂体瘤。如果肿瘤变大，视力可能会受损。与其他垂体瘤不同，卡麦角林（CAB）对泌乳素瘤极为有效，已成为一线治疗药物。在本研究中，我们考察了对伴有视力损害（VI）的泌乳素瘤进行药物和手术治疗的经验，以确定VI是否可作为手术指征。此外，我们还讨论了在泌乳素瘤治疗的金标准是给予CAB的情况下手术的作用。2009年至2021年期间，东京女子医科大学医院收治了159例泌乳素瘤患者（年龄13 - 77岁[平均36.3岁]；男性29例，女性130例），其中18例（年龄15 - 67岁[平均35.8岁]；男性12例，女性6例）有VI（主观上12例，客观上6例）。他们立即开始CAB治疗（最大剂量：0.5至6毫克/周；平均：2.17毫克/周）。16例患者（88.9%）的VI有所改善，但2例（11.1%）未改善，这2例需要手术治疗。其中1例患者的实质性肿瘤对CAB耐药，另1例因肿瘤内出血形成囊性肿瘤。因此，由于其显著的高改善率，CAB是伴有VI的泌乳素瘤的一线治疗药物。然而，对于对CAB耐药的病例，需要密切且严格的监测，并且需要根据手术目的在适当的时机做出关于手术干预的正确决策以及选择合适手术方式。
