Serri O, Rasio E, Beauregard H, Hardy J, Somma M
N Engl J Med. 1983 Aug 4;309(5):280-3. doi: 10.1056/NEJM198308043090505.
To assess the long-term prognosis for women with prolactinoma after selective transsphenoidal adenomectomy, we followed 44 patients for 6.2 +/- 1.5 years. Group 1 (28 patients) had microprolactinomas, and Group 2 (16 patients) had macroprolactinomas. After surgery, normal plasma prolactin levels, resumption of menses, and cessation of galactorrhea were observed in 24 Group 1 patients (85 per cent) and 5 Group 2 patients (31 per cent). Hyperprolactinemia recurred in 12 of the 24 Group 1 patients and in 4 of the 5 Group 2 patients after 4 +/- 1.3 and 2.5 +/- 1.6 years of remission, respectively. There was no radiologic evidence of tumor recurrence in any patient, and no relation was found between the occurrence of pregnancy after surgery and the recurrence of hyperprolactinemia. Clinical and biologic features before surgery could not predict the long-term outcome. However, the immediate postoperative level of plasma prolactin was significantly lower in patients in whom normal prolactinemia (6.4 +/- 1.1 ng per milliliter) was maintained than in those who relapsed (11.7 +/- 1.5 ng per milliliter) (P less than 0.02). We conclude that recurrence of hyperprolactinemia after successful surgery is frequent but delayed. The immediate postoperative level of plasma prolactin may be a predictive risk factor.
为评估选择性经蝶窦腺瘤切除术后泌乳素瘤女性患者的长期预后，我们对44例患者进行了6.2±1.5年的随访。第1组（28例患者）为微泌乳素瘤，第2组（16例患者）为大泌乳素瘤。术后，第1组24例患者（85%）出现血浆泌乳素水平正常、月经恢复和溢乳停止，第2组5例患者（31%）出现上述情况。第1组24例患者中的12例以及第2组5例患者中的4例分别在缓解4±1.3年和2.5±1.6年后高泌乳素血症复发。所有患者均无肿瘤复发的影像学证据，且未发现术后妊娠与高泌乳素血症复发之间存在关联。术前的临床和生物学特征无法预测长期预后。然而，术后维持正常泌乳素血症（6.4±1.1 ng/ml）的患者术后即刻血浆泌乳素水平显著低于复发患者（11.7±1.5 ng/ml）（P<0.02）。我们得出结论，成功手术后高泌乳素血症复发很常见，但会延迟出现。术后即刻血浆泌乳素水平可能是一个预测风险因素。
