Пролактиноми: чи можлива хірургічна гормональна ремісія?

Abstract

Prolactinomas: is it possible to achieve hormonal remission surgically? Purpose. Tо determine the efficacy of endoscopic endonasal transsphenoidal method for the treatment of prolactinomas.Materials and methods. Endoscopic endonasal trassphenoidal (EET) access was performed in all cases. Depending on the size, we were isolated: the pituitary microadenomas (up to 10mm) – 6 macroadenomas (10–40 mm) – 12 giant adenomas (>40 mm) – 3. Clinical manifestations were presented in: visual disorders – 9 patients, including: visual acuity – 6, visual field disorders – 3, diplopia – 2; hormonal disorders – 14 patients, including: menstruation disorders – 9, obesity – 4 galactorrhea – 3.Results and discussion. The average serum prolactin was 530 ng/ml, the maximum levels was – 1440 ng/ml, the minimum was – 65 ng/ml. Normal prolactin level was achieved postoperatively in 5 (100%) cases of microadenomas, and in 7 (58,3%) cases of macroadenomas without DA. After EET surgery normoprolactinemia was achieved in 12 (60%) patients, 8 (40%) cases required DA therapy within a year. Hormonal disorders’ remission after surgery was achieved in 10 (76,9%) cases. In 6 (30%) cases, any hormonal disorders ware identified. Visual acuity was improved in all cases. Any postoperative complications like CSF leak, meningitis, additional oculomotor disorders or any other visual disorders were identified. No mortality was observed in our research.Conclusions. Endoscopic endonasal transsphenoidal technique is effective for prolactinomas treatment and allows to improve rate of hormone level in 60%. In case of microprolactinomas improving hormone level and hormonal disorders is possible in 100% without DA therapy.