Clinical study on pituitary adenoma with hyperprolactinemia (author's transl)

Abstract

Clinical symptoms, endocrinological findings, neuroradiological findings, and the results of treatments were studied in 24 patients with pituitary adenoma with hyperprolactinemia (over 30 ng/ml). The excised tumor tissues were examined light-microscopically and electron-microscopically, and hormones in the tumor culture medium were measured. The subjects in this study were 19 female and 5 male patients. All of the female patients had had amenorrhea and 14 of them had shown galactorrhea. Nine of the 24 patients had had visual disturbance and 2 had had diplopia or blephaloptosis. These 24 patients were classified into 3 groups according to the prolactin (PRL) values and the neuroradiological findings. The first group consisted of 4 patients who were rather aged (mean age, 44.5 years) and had low PRL values ranging from 30 to 112 ng/ml. The tumor showed suprasellar extension, and all the 4 patients had had visual disturbance. Electron microscopy and immunological staining did not yield confirmation of PRL-productive pituitary adenoma. The second group consisted of 12 patients who had high PRL values ranging from 116 to 1, 040 ng/ml. The tumor was intrasellarly localized. PRL value returned to normal after surgery in 18% of the patients. Menstruation started again in 27% of them. After administration of CB154 the PRL value was restored to normal in 75% of them, and menstruation started again in all of the 12 patients. The third group consisted of the remaining 8 patients where the tumor showed parasellar extension. Sufficient effects could not be obtained by surgery alone. Even after administration of CB154, the PRL value was restored to normal in only 2 of the 8 patients, and menstruation and pregnancy were observed in only 1 of the 4 female patients. Thus, patients who belong to the second and third groups with PRL-productive pituitary adenoma should be treated as follows: In patients with PRL-productive intrasellarly localized pituitary adenoma, the tumor should be totally excised. In patients with PRL-productive pituitary adenoma which invades the cavernous sinus and so cannot be totally excised, CB154 should be administered after surgery.