Transsphenoidal microsurgery for prolactin-secreting pituitary adenomas

Results in 100 women with the amenorrhea-galactorrhea syndrome

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✓ The authors present the results of transsphenoidal microsurgery in 100 women with the amenorrhea-galactorrhea syndrome caused by pituitary adenomas associated with hyperprolactinemia (prolactinomas). As the surgical results were closely related to the preoperative levels of serum prolactin, the patients were divided into two groups: patients with preoperative prolactin less than 200 ng/ml (Group 1), and those with preoperative prolactin greater than 200 ng/ml (Group 2). The results in Group 1 (72 patients) were significantly better. In this group, 56 (78%) patients regained normal menstrual cycles, and 55 (76%) had return of elevated prolactin levels to normal following surgery. In Group 2 (28 patients), however, only 11 (39%) resumed normal menstrual periods postoperatively, and 13 (46%) had return of elevated prolactin levels to normal. There was good correlation between tumor size and the preoperative level of prolactin. Of the 72 women in Group 1, 58 (81%) had tumors less than 1 cm (microadenomas), whereas of the 28 women in Group 2, only four (14%) had tumors of that size. All patients with visual field deficits preoperatively improved or had a normal visual examination postoperatively; none was made worse by surgery. Four patients (three in Group 2) have required additional surgery and/or irradiation.

In the last six patients of the series, contrast-enhanced coronal computerized tomography slices made with the updated General Electric scanner detected five microadenomas. Considering that a relatively high percentage of sellar polytomograms are negative in patients with proven microadenomas (that is, only 40 of 72 patients in Group 1 had abnormal polytomography), it is likely that sellar polytomography will significantly decrease in importance in the diagnostic work-up of these patients. The authors provide a rationale for transsphenoidal microsurgery in these patients as opposed to other forms of management, such as bromocriptine therapy and irradiation.

Article Information

Address reprint requests to: Miguel A. Faria, Jr., M.D., Section of Neurological Surgery, Emory University Clinic, 1365 Clifton Road, N.E., Atlanta, Georgia 30322.

© AANS, except where prohibited by US copyright law.

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    Contrast-enhanced computerized tomography scans in the coronal projection. Left: An adenoma is visualized as a radiolucent 5-mm lesion in the left side of the sella (arrows). There are no associated bone changes in the sella floor, except for inferior sloping of the sella in the area of the lesion. At surgery, a microadenoma was found at the left side of the sella. Right: A highly dense, discrete lesion associated with focal thinning of the sella is seen (arrows). A calcified 8-mm tumor was removed at surgery. Histologically, the tumor was found to be a pituitary adenoma filled with calcospherites.

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