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.
