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Journal of Neurosurgical Sciences 2001 June;45(2):65-9

Copyright © 2001 EDIZIONI MINERVA MEDICA

lingua: Inglese

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


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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.

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