Wallace E A, Holdaway I M
Department of Endocrinology, Auckland Hospital.
N Z Med J. 1995 Feb 22;108(994):50-2.
A retrospective review of management of patients with macroprolactinomas at Auckland Hospital 1974-93 to determine the efficacy of treatment.
Patients were identified from departmental patient disease index records and treatment outcome assessed.
Thirty four patients (24 male, 10 female) were identified. The mean serum prolactin was 89,700mIU/L. Visual field defects were present in 20 and 24 were hypogonadal at presentation. Initial treatment was with bromocriptine (n = 24) or surgery (n = 7). Twelve medically treated patients were subsequently treated surgically (3 because of pituitary haemorrhage or infarction, nine because of slow or absent response to medication). Visual field improvement was similar in the medical and surgical groups and major treatment complications occurred in 3 of the medical and 3 of the surgical patients. Radiotherapy was given to 25 patients. Overall treatment responses over a mean follow up of 4 years were similar in surgically and medically treated patients. Overall only a third of patients had a normal serum prolactin at last follow up, pregnancy had occurred in 20% of potentially fertile patients and 35% were hypopituitary.
Bromocriptine is a satisfactory first line treatment for macroprolactinomas, but although treatment reduces tumour size and reverses field defects in 75% of cases only one third of patients achieve a normal prolactin over medium term follow up.
对1974年至1993年奥克兰医院大泌乳素瘤患者的治疗进行回顾性研究，以确定治疗效果。
从科室患者疾病索引记录中识别患者并评估治疗结果。
共识别出34例患者（24例男性，10例女性）。血清泌乳素平均水平为89,700mIU/L。20例存在视野缺损，24例就诊时存在性腺功能减退。初始治疗采用溴隐亭（24例）或手术（7例）。12例接受药物治疗的患者随后接受了手术（3例因垂体出血或梗死，9例因对药物反应缓慢或无反应）。药物治疗组和手术治疗组的视野改善情况相似，药物治疗组和手术治疗组各有3例出现主要治疗并发症。25例患者接受了放射治疗。手术治疗和药物治疗患者平均随访4年的总体治疗反应相似。总体而言，最后一次随访时只有三分之一的患者血清泌乳素正常，20%有生育能力的患者怀孕，35%存在垂体功能减退。
溴隐亭是大泌乳素瘤令人满意的一线治疗药物，但尽管治疗可缩小肿瘤大小并使75%的病例视野缺损得到改善，但在中期随访中只有三分之一的患者泌乳素恢复正常。
