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Low recurrence rate after partial hypophysectomy for prolactinoma: the predictive value of dynamic prolactin function
J Webster1, M D Page, J S Bevan
1Department of Medicine, University of Wales College of Medicine, Cardiff, UK.
Clinical Endocrinology
|January 1, 1992
Summary
Transethmoidal partial hypophysectomy can be effective for prolactinoma. Dynamic prolactin (PRL) tests predict outcomes and identify patients at risk for recurrence after surgery.
Area of Science:
- Neurosurgery
- Endocrinology
- Oncology
Background:
- Prolactinoma, a common pituitary tumor, is often treated with dopamine agonists.
- Transethmoidal partial hypophysectomy offers a surgical alternative for select patients.
- Predicting surgical success and recurrence risk is crucial for patient management.
Purpose of the Study:
- To identify factors influencing transethmoidal partial hypophysectomy outcomes for prolactinoma.
- To evaluate the predictive value of pre- and post-operative dynamic prolactin (PRL) function tests.
Main Methods:
- Retrospective study of 82 hyperprolactinemic patients diagnosed with prolactinoma.
- Dynamic PRL and TSH responses to domperidone and TRH were measured pre- and post-operatively.
- CT scans and operative findings were analyzed.
Main Results:
- Early cure rates varied by adenoma size, with smaller adenomas (5-9 mm) showing the highest success (96%).
- Preoperative PRL levels strongly correlated with cure rates; higher levels indicated lower success.
- Dopamine agonist therapy prior to surgery reduced early cure rates in macroadenoma patients.
- Post-operative TSH responses predicted late recurrence risk.
Conclusions:
- Transethmoidal partial hypophysectomy is a viable treatment for carefully selected prolactinoma patients.
- Dynamic tests effectively identified non-adenomatous hyperprolactinemia preoperatively.
- Post-operative dynamic tests identified patients at higher risk for late recurrence.