Treatment of Giant Prolactin-Secreting Pituitary Adenomas: A Choice of Tactics

B.A. Kadishev, L.I. Astafeva

Burdenko Research Institute of Neurosurgery, Moscow, Russia

 

Surgical treatment of giant pituitary adenomas is one of the most complicated problems of modern neurosurgery. It was the main method of treatment before appearance of dopamine agonists. Achievements of up-to-date pharmacology have allowed to start using alternative treatment of giant prolactinomas (GP).

The study goal has been comparison of surgery and drug therapy of GP.

Material and Methods. There were 57 cases (41 males and 16 females) with pituitary adenomas, whose maximum size was more than 6 cm, and a level of prolactin of 55600-1323000 mU/l (the median of 213615 mU/l). Their age varied from 18 up to 67 years. Operations were made in 34 cases: 23 patients received cabergoline as an initial method of treatment.

Results. As for 26 operated cases, who had had visual disorders, vision improvement, its deterioration and absence of any dynamics were watched in 57.7%, 27% and 15.3% of them. Symptoms of hypothyrosis and hypocorticoidism were revealed in 42% of cases: 29% of patients developed diabetes insipidus. There were 3 fatal outcomes (8.8%). A level of prolactin became normal in 3% of cases; hyperprolactinemia was persistent in 97% of cases. There were 20 cases with visual disorders among those, receiving cabergoline. Vision improvement and absence of dynamics were seen in 75% and 25% of cases, respectively. There was not a single case with its deterioration or symptoms of hypothyrosis and hypocorticoidism. A level of prolactin reduced in all cases and was 400-58000 mU/l (the median of 2100). It became normal in 43% of cases. MR-examination revealed decrease of a tumor size in 91% of cases.

Conclusion. In our opinion, it is expedient to start treatment of GP with drug therapy, using dopamine agonists. Taking into account dynamics of symptoms, conditioned by reduction of a tumor size and prolactin production, one can say, that it is more effective and safe in comparison with surgical treatment.