ORIGINAL ARTICLES   

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

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.