1981 Volume 21 Issue 5 Pages 467-475
The authors evaluated results of surgical treatment for 12 cases of prolactin-secreting pituitary microadenomas with respect to the effect on the endocrinological status and compared these results with those for 10 cases of macroadenomas.
The cases of microadenomas were all female; 10 cases with amenorrhea and galactorrhea, a case with oligomenorrhea and galactorrhea and a case with only amenorrhea. Both microadenomas and macroadenomas were operated on through the transsphenoidal route. Microadenomas were considered to have been removed completely but macroadenomas were not always removed completely because of their larger size.
The relation between operative findings of microadenomas and basal serum PRL levels was analysed. Two elastic and firm adenomas showed elevated serum PRL levels (p<0.001) exceeding 400 ng/ml and two eosinophilic and two mixed adenomas showed higher serum PRL levels than the chromophobes (p<0.01). Adenomas with serum PRL levels around or over 200 ng/ml were all peripheral types. Localization within the sella turcica or size of the tumors had little relation to serum PRL levels.
In microadenomas, serum PRL levels fell to the normal level in nine cases (75.0%) within a month after the operation. Three cases with normal PRL levels, however, gradually returned to elevated levels in the follow-up after a month. Conversely, no drop to the normal level was observed in cases of macroadenomas.
Surgical impacts on HGH, TSH, LH, FSH and ACTH reserves were examined. Only four out of 18 cases (22.2%) among the microadenomas and macroadenomas had impaired hormonal reserves after transsphenoidal surgery which was considered to be a safe procedure.
Regular menses were restored in nine out of 12 cases (75.0%) of microadenomas after a mean interval of a month and a half after the operation. Six cases showed ovulatory menses. One case experienced normal delivery and two cases became pregnant among the six patients. Galactorrhea disappeared in nine out of 11 cases (81.8%) of microadenomas after a mean interval of 2 months and a half after the operation and another case showed a remarkable decrease in lactation. However, none of the seven cases of macroadenomas showed restored menses, only one out of six cases had cessation of lactation and another two cases showed a decrease in lactation after the operation.
Transsphenoidal removal of prolactin-secreting microadenomas was a safe and satisfactory treatment of choice.
