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JOURNAL OF NEUROSURGICAL SCIENCES
Rivista di Neurochirurgia
Indexed/Abstracted in: e-psyche, EMBASE, PubMed/MEDLINE, Neuroscience Citation Index, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,651
Journal of Neurosurgical Sciences 2001 June;45(2):65-9
A comparative evaluation of effectiveness of medical and surgical therapy in patients with macroprolactinoma
Acquati S. 1, Pizzocaro A. 1, Tomei G. 2, Giovanelli M. 3, Libè R. 1, Faglia G. 1, Ambrosi B. 1
1 Institute of Endocrine Sciences, Ospedale Maggiore IRCCS, University of Milan, Italy;
2 Institute of Neurosurgery, Ospedale Maggiore IRCCS, University of Milan, Italy;
3 Neurosurgical Clinic, Ospedale S. Raffaele IRCCS, Milan, Italy
Background. The surgical success rate in macroprolactinomas is quite low, while medical treatment is more effective in reducing PRL levels and tumour mass. In this study the effectiveness of surgical, medical and radiant approaches on clinical symptoms, PRL levels and tumour size were compared in a large series of patients with macroprolactinomas.
Methods. One hundred and thirty-two patients (63 males and 69 females) were followed-up. Eighty-three patients were operated by trans-sphenoidal (TSS) approach: 18 underwent only TSS, 10 were operated and then irradiated; 30 patients underwent TSS and dopamine agonists, 25 were treated by TSS, radiotherapy and dopamine agonists. One hundred and four patients were treated by medical therapy: 49 patients were only administered dopamine agonists and 55 were given dopamine agonists after unsuccessful surgery and/or radiotherapy.
Results. In 83 patients serum PRL levels decreased from 1873±319.9 ng/ml to 831.6±297.8 ng/ml after trans-sphenoidal surgery: a significant PRL reduction was obtained in 18 cases (22%) and a full PRL normalization was found in 15 patients (18%). The pituitary adenoma was completely removed in the 15 cases, in whom serum PRL normalized. Sexual function was restored in 57% of women and in 29% of men. In contrast, dopaminergic drugs normalized PRL levels (from 1590.5±232.7 to 19.2±4.8 ng/ml) in 93/104 patients (89%). Sexual function was restored in 74% of women and in 75% of men. Radiotherapy, performed after unsuccessful TSS, was ineffective in normalizing PRL levels.
Conclusions. Medical therapy should be considered the first choice treatment in macroprolactinomas, while the surgical approach is recommended when neurological compressive symptoms are present and in patients resistant or intolerant to dopamine agonists. Radiotherapy may be indicated only in the patients in whom medical and surgical therapy have not been successful.