Nagatani M, Ikeda T, Otsuki H, Mizuta T, Mori S, Ushio Y, Hayakawa T, Mogami H, Matsumoto K, Mori H
No Shinkei Geka. 1984 Mar;12(3 Suppl):339-46.
A 51-year-old house woman visited the Department of Neurosurgery, Osaka University Hospital for examination of the head injury on Oct. 7, 1975. Neurological examination was normal. Endocrinological examination showed galactorrhea. The patient had a past history of premature menopause. Plain skull films revealed enlargement of sella turcica and CT scan showed sellar tumor with suprasellar expansion which was enhanced by contrast medium. The serum prolactin (PRL) level was 3,290 ng/ml. Diagnosis of PRL secreting pituitary adenoma (prolactinoma) was made. Though surgical removal of the tumor was recommended, it was refused by the patient. Therefore, careful observation was continued as an out-patient until May 1979 when she noticed a temporal hemianopsia of her left eye. She was admitted and had partial removal of the tumor via frontal route and subsequent irradiation (total dose of 5,000 rad by Lineac). The tumor was verified to be a prolactinoma by the immunohistochemical staining. Postoperative course was uneventful and she lead a normal life. In Oct. 1981, severe faceache began and she was readmitted. Sella was destructed extensively and CT scan revealed a hugh sellar tumor with multi-directional extrasellar extension which was less enhanced than that of the first study. The serum PRL level was 588 ng/ml and the regrowth of prolactinoma was suspected. High dose bromocriptine (40 mg/day) therapy was started. The serum PRL level rapidly fell to the negligible value, however, shrinkage of the tumor was not observed. On Jan. 20, 1982, suddenly she developed a left hemiparesis and her level of consciousness gradually deteriorated. On Mar. 11, 1982, the second operation was performed and a solid firm tumor in the base of the skull was partially removed. The tumor was histologically verified to be a fibrosarcoma. After the second operation bromocriptine therapy was discontinued, however expected elevation of the serum PRL level was not recognized. She died on Apr. 4, 1982.
1975年10月7日，一名51岁的家庭妇女因头部受伤前往大阪大学医院神经外科就诊。神经系统检查正常。内分泌检查显示有溢乳现象。该患者有过早绝经史。头颅平片显示蝶鞍扩大，CT扫描显示鞍区肿瘤并向鞍上扩展，增强造影剂后有强化。血清催乳素（PRL）水平为3290 ng/ml。诊断为分泌PRL的垂体腺瘤（催乳素瘤）。尽管建议手术切除肿瘤，但患者拒绝了。因此，作为门诊患者继续密切观察，直到1979年5月，她发现左眼颞侧偏盲。她入院并通过额部入路进行了肿瘤部分切除，随后进行了放疗（直线加速器总剂量5000拉德）。通过免疫组织化学染色证实肿瘤为催乳素瘤。术后过程顺利，她过上了正常生活。1981年10月，开始出现严重的面部疼痛，她再次入院。蝶鞍被广泛破坏，CT扫描显示一个巨大的鞍区肿瘤，向鞍外多方向延伸，强化程度比第一次检查时低。血清PRL水平为588 ng/ml，怀疑催乳素瘤复发。开始高剂量溴隐亭（40毫克/天）治疗。血清PRL水平迅速降至可忽略不计的值，然而未观察到肿瘤缩小。1982年1月20日，她突然出现左侧偏瘫，意识水平逐渐恶化。1982年3月11日，进行了第二次手术，部分切除了颅底的一个实性坚硬肿瘤。肿瘤经组织学证实为纤维肉瘤。第二次手术后停用溴隐亭治疗，但未发现血清PRL水平如预期升高。她于1982年4月4日去世。
