Transsphenoidal surgery for prolactinomas in male patients: a retrospective study / 亚洲男科学杂志(英文版)

Male patients with prolactinomas usually present with typical hyperprolactinemia symptoms, including sexual dysfunction and infertility. However, clinical factors related to sexual dysfunction and surgical outcomes in these patients remain unclear. This study aimed to investigate the outcomes of male patients with prolactinomas after transsphenoidal surgery and the risk factors affecting sexual dysfunction. This study was conducted on 58 male patients who underwent transsphenoidal surgery for prolactinomas between May 2014 and December 2020 at the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. We evaluated the sexual function of patients before and after surgery through International Index of Erectile Function-5 scores, libido, and frequency of morning erection. Of the 58 patients, 48 (82.8%) patients had sexual intercourse preoperatively. Among those 48 patients, 41 (85.4%) patients presented with erectile dysfunction. The preoperative International Index of Erectile Function-5 scores in patients with macroprolactinomas were significantly higher than those in patients with giant prolactinomas (17.63 ± 0.91 vs 13.28 ± 1.43; P = 0.01). Postoperatively, the incidence of erectile dysfunction was 47.9%, which was significantly lower than that preoperatively (85.4%; P = 0.01). Twenty-eight (68.3%) patients demonstrated an improvement in erectile dysfunction. Tumor size and invasiveness were significantly correlated with the improvement of erectile dysfunction. Preoperative testosterone <2.3 ng ml-1 was an independent predictor of improvement in erectile dysfunction. In conclusion, our results indicated that tumor size and invasiveness were important factors affecting the improvement of sexual dysfunction in male patients with prolactinoma. The preoperative testosterone level was an independent predictor related to the improvement of erectile dysfunction.

Risk factors and the prognosis of sexual dysfunction in male patients with pituitary adenomas: a multivariate analysis / 亚洲男科学杂志(英文版)

The impact of sexual dysfunction (SD) is distressing to many male patients with pituitary adenomas which affect both physical and psychological health. The research explored to identify risk factors affecting sexual function and the prognosis of male patients with pituitary adenomas. Two hundred and fifty-four male patients, who aged between 18 and 60 (mean ± s.d.: 44.16 ± 10.14) years and diagnosed with pituitary adenomas, were retrospectively analyzed. One hundred and fifty-nine patients (62.6%) complained of SD prior to surgery. The mean International Index of Erectile Function (IIEF-5) in patients with giant adenomas was 16.13 ± 2.51, much smaller than those with microadenomas or macroadenomas (P < 0.05). All the patients showed significant improvement in terms of erectile dysfunction (ED) following surgery (P < 0.05). In addition, complete resection achieved a higher degree of SD relief than partial resection. The incidence of SD in functioning pituitary adenomas (FPAs) was much higher than that in nonfunctioning pituitary adenomas (NFPAs) (P < 0.05). In addition, compared with NFPAs, males with prolactinomas (82.8%) had the higher prevalence of SD and significantly improvement following surgical intervention (P < 0.05). An inverse relationship was identified between decreasing testosterone levels and increasing incidence of SD before surgery (P < 0.05). There was no significant difference between 6 months and 12 months after surgery in serum testosterone level (P > 0.05). Our results indicated that surgical therapy could be optimized for improvements in SD and that testosterone levels can be used as a sensitive indicator to predict the recovery rate of sexual function in patients with pituitary adenomas following surgery and the serum testosterone level will stay stable in 6 months after surgery.

Progressão de Valvopatia Esquerda durante o Uso de Dopaminérgicos / Progression of Left Valve Disease during Use of Dopaminergic Drugs

A cabergolina e a bromocriptina são drogas dopaminérgicas derivadas do ergot e utilizadas para tratamento de distúrbios hiperprolactinêmicos idiopáticos ou adenomas hipofisários, cujo mecanismo de ação é decorrente da redução da secreção de prolactina. Alguns relatos na literatura demonstram que a cabergolina pode causar valvopatia após sua administração a longo prazo. Relatamos o caso de um paciente com diagnóstico de macroprolactinoma que fez uso intercalado de cabergolina e bromocriptina e desenvolveu alterações valvares antes inexistentes

Pituicitoma hipofisario, un hallazgo diagnóstico inusual: reporte de caso / Pituitary pituicytoma, finding of an unusual diagnosis: a case report

Los pituicitomas son tumores infrecuentes de la región selar y supraselar, originados de la neurohipófisis, que suelen ser confundidos con otros tumores al compartir características imaginológicas. Se reporta el caso de una mujer de 36 años de edad, con un pituicitoma en la región selar, que fue diagnosticado como un adenoma hipofisario debido a los hallazgos clínicos e imaginológicos preoperatorios y se realiza una revisión de la literatura.

The Pituicytomas are rare tumors of the sellar and suprasellar region originated of the neurohypophysis and are usually confused with other tumors when sharing imagining features. It is reported a case of a 36 years old woman with pituicytoma in the sellar region that was diagnosed as a pituitary adenoma due to the presurgical clinical and imaging findings and, it is revised the literature.

Osteomielitis por Yokenella regensburgei después de una craneotomía en una paciente inmunocompetente / Osteomyelitis due to Yokenella regensburgei following craniotomy in an immunocompetent patient

Yokenella regensburgei es un bacilo Gram negativo de la familia Enterobacteriaceae, que puede encontrarse en agua de pozos, alimentos y en el tubo digestivo de insectos y reptiles. Aunque se ha aislado de muestras provenientes de seres humanos, pocas veces se ha reportado como causante de infección y, en tales casos, especialmente en pacientes inmunosuprimidos. Se presenta aquí el primer caso de osteomielitis secundaria a una infección por Y. regensburgei en una paciente inmunocompetente después de un procedimiento quirúrgico.

The gram-negative bacillus Yokenella regensburgei (of the Enterobacteriaceae family) can be found in groundwater and foodstuffs, as well as the digestive tracts of insects and reptiles. Although it has been isolated from humans since its original description, it has rarely been reported as a cause of infection, and then, only in immunosuppressed patients. We report the first case of post-surgical secondary osteomyelitis due to Y. regensburgei in an immunocompetent woman who had undergone a craniotomy.

Resultados visuales en pacientes con macroprolactinoma tratados con agonistas de dopamina / Visual outcome in patients with macroprolactinoma treated with dopamine agonists

Background: Dopamine agonists (DA) effectively reduce tumor size of macroprolactinomas, with the consequent improvement of eventual visual impairment. Aim: To study the visual outcomes in patients with macroprolactinoma treated with DA. Material and Methods: Retrospective cohort study which included patients with macroprolactinoma controlled at a Neuro-endocrinology and Neuro-ophthalmology Department between 1997'and2011, and treated exclusively with DA (bromocriptine or cabergoline). Patients who were operated or had previous radiotherapy and those with an incomplete follow up, were excluded. We analyzed and compared the visual status before and after the beginning of DA treatment. Results: Thirty one patients aged 8 to 59years, were included. Eighteen patients (58%) had visual impairment at the moment of diagnosis (group 1) and 13 had no alterations (group 2). Mean follow up was 36.5 months. Fifteen patients from group 1 (83%) had visual improvement, two remained stable (11 %) and one had a visual deterioration (6%). In group 2, only one non-compliant patient had a visual deterioration. Conclusions: DAs are effective in the management of neuro-ophthalmic complications associated to macroprolactinomas and should be considered asfirst choice therapy in these tumors.

Controle hormonal dos adenomas hipofisários pela cirurgia transesfenoidal: evolução dos resultados nos primeiros cinco anos de experiência / Hormonal control of pituitary adenomas by transsphenoidal surgery: results of the first five years of experience

OBJETIVO: Avaliar os resultados iniciais de uma equipe cirúrgica no controle hormonal dos adenomas hipofisários secretores. MATERIAIS E MÉTODOS: Em cinco anos, foram operados 51 adenomas secretores (31 GH, 14 ACTH, 5 prolactina, 1 TSH). O controle hormonal foi GH basal < 2,5 ng/dL, cortisol livre urinário normal, redução dos níveis de prolactina, e T3 e T4 livre normais. RESULTADOS: As taxas de controle foram 36 por cento na acromegalia e 57 por cento no Cushing. Dois prolactinomas (40 por cento) normalizaram a prolactina. Os hormônios tiroidianos normalizaram no adenoma secretor de TSH. O controle do hipercortisolismo correlacionou-se com o tempo de experiência da equipe (p = 0,01). CONCLUSÃO: Nossos resultados, limitados aos primeiros anos de experiência cirúrgica, situam-se abaixo da variação reportada em grandes casuísticas com maior tempo de experiência. Ao longo do tempo, observou-se melhora progressiva nos níveis de cortisol urinário no pós-operatório inicial da doença de Cushing em função da experiência cirúrgica.

OBJECTIVE: To evaluate the initial results of a surgical team in the hormonal control of secreting pituitary adenomas. MATERIALS AND METHODS: In five years 51 functioning adenomas were operated (31 GH-secreting, 14 ACTH-secreting, 5 PRL-secreting and 1 TSH-secreting). Hormonal control was defined as GH < 2,5 ng/mL, normal free-urinary cortisol, lower prolactin and normal T3 and FT4. RESULTS: Control rates were 36 percent in acromegaly, and 57 percent in Cushing's disease. Two prolactinomas normalized prolactin levels. Thyroid hormone levels were normalized in the TSH-secreting adenoma. Control of hypercortisolism was positively correlated with years of experience (p = 0.01). CONCLUSION: Our results, although restricted to the beginning of our experience, lie below the reported range of other surgical series with much longer experience. During these years, there was a significant improvement in initial post surgery urinary cortisol levels in Cushing's disease as a function of surgical experience.

Prolactinoma gigante de inicio en la adolescencia: a propósito de 2 casos clínicos / Report of two adolecents with giant prolactinomas

The prevalence of pituitary among adolescents is 0.1 per million and the most common type is prolactinoma. We report two adolescents with pituitary adenomas. A 15 years old female presenting with a progressive reduction of visual acuity, headache and galactorrhea. Magnetic resonanceshowed a sellar tumor with suprasellar expansion. She was subjected to transcraneal surgery and the pathological study of the piece disclosed a prolactinoma. A 23 years old male presenting with weight gain, headache and decreased visual acuity of the left eye. Magnetic resonance demonstrateda tumor with sellar and suprasellar involvement. He was subjected to transsphenoidal surgery and the pathological study of the surgical piece disclosed a prolactinoma.

Manejo atual dos macroprolactinomas: revisão de literatura / Current management of macroprolactinomas: literature review

Tumores hipofisários secretores de prolactina representam ate 64 por cento do total de adenomas secretores. A proporção superior de macroprolactinomas em homens ainda não tem sua causa estabelecida, apesar de estudos moleculares iniciais apontarem para um provável crescimento tumoral acelerado no sexo masculino; uma outra causa seria a apresentação clínica diferente entre os sexos. O tratamento farmacológico apresenta-se como escolha inicial na maioria dos casos, com altas taxas de controle tumoral mediante o uso de agonistas dopaminérgicos. A cirurgia é indicada principalmente a pacientes que não toleram ou não obtém bons resultados com as medicações, em tumores de grande conteúdo cístico e em casos de apoplexia hipofisária. A indicação da radioterapia ainda não está bem definida, porém os melhores resultados obtidos atualmente com o uso de radiocirurgia indicam o possível papel dessa modalidade no tratamento de adenomas que não responderam adequadamente à cirurgia nem ao tratamento clínico...

complicated case of prolactinoma

The clinical course of a forty-two year old lady who was diagnosed having pituitary prolactinoma, treated with dopaminergic agonists, surgery and radiation therapy is presented. This report describes the clinical progression, laboratory and imaging findings and treatments offered throughout the course

Cirugía transeptoesfenoidal en adenomas hipofisarios productores de prolactina / Transeptosphenoidal surgery in prolactin-secreting hypophyseal adenomas

El tratamiento actual de los prolactinomas es básicamente médico, teniendo en cuenta los buenos resultados alcanzados con los nuevos agonistas dopaminérgicos. No obstante, la adenomectomía selectiva clasifica entre las modalidades de tratamiento para aquellos prolactinomas que no respondan a este. El objetivo del presente trabajo fue evaluar los resultados del tratamiento microquirúrgico por vía transeptoesfenoidal de los adenomas productores de prolactina en el servicio de Neurocirugía del Hospital Hermanos Ameijeiras, para lo cual presentamos un estudio retrospectivo y descriptivo de 63 pacientes intervenidos por vía sublabial transeptoesfenoidal microquirúrgica portadores de este tipo de adenomas, y tratados en nuestro servicio desde 1996 hasta el 2003. Se analizaron la edad, el sexo, el cuadro clínico, el tamaño de las lesiones, los niveles hormonales, así como las complicaciones y la evolución posoperatoria. Como resultado se encontró un franco predominio del sexo femenino: 86(por ciento) (54 pacientes). Se operaron 31 pacientes con macroadenomas y 32 con microadenomas. Los síntomas más frecuentes mejoraron, sobre todo la cefalea, en el 82(por ciento) (36 casos) y los trastornos visuales en el 69 (18 casos). La complicación más común en el posoperatorio fue la diabetes insípida transitoria (11 enfermos). Se logró reducir las cifras iniciales de prolactina a valores no tumorales en el 90,6 de lo microadenomas (29 casos) y en el 67,7 de los macroadenomas (21 casos). Se concluye que la adenomectomía transeptoesfenoidal es un proceder seguro y eficaz como opción de tratamiento para pacientes con adenomas secretores de prolactina que tengan indicación quirúrgica(AU)

audit of outcome of treatment in patients with acromegaly at mansoura University Hospital

Aim: In the last decade, there has been much change concerning treatment of patients with acromegaly. Although stringent criteria for cure or remission in acromegaly are advocated by many authors, there is still much controversy about cure rates using different endocrinologic criteria and factors behind the different outcomes in different centers. Because patients with acromegaly are cared for by many specialties including the endocrinologist, the neurosurgeon, and the radiotherapist, pooled data about the outcome of different modalities of treatment are lacking in our hospital. The aim of the present study was to review our patients with acromegaly, therapeutic modalities used, and to evaluate the outcome in lights of the international reports. Subjects and A series of 26 cases with acromegaly due to pituitary adenoma attending the Mansoura Endocrinology and Neurosurgery outpatient clinics and inpatient departments, were assessed retrospectively. Clinical, full endocrinologic and biochemical assessment including serum GH, prolactin, TSH and ACTH were made. Neuroimaging data including MRI and/or CT of the pituitary were examined. Ophthalmologic examination including fundus and field of vision, both pre- and postoperatively were analyzed. Remission was considered at GH level of less than 5 ng/ml. Twenty four patients have undergone transsphenoidal pituitary adenomectomy, combined with external conventional radiotherapy and bromocriptin therapy at a dose of 10 mg/day in divided doses. Two patients accepted only medical treatment. Follow up period ranged from 1 to 6 years with an average of 3 years with serial endocrinal, biochemical and neuroimaging assessment. Patients analyzed included 6 females and 20 males with an age ranging from 27 to 62 years. All females were postmenopausal and were significantly older than males. Clinical features of acromegaly, as abnormal facial features, hyper-hidrosis, hypertension, diabetes, and musculoskeletal abnormalities were not different from those reported in the literature. Pituitary microadenoma was found only in one patient, while macroadenoma confined to the sella was found in 12 cases [46%], and macroadenoma with extrasellar extensions was found in 13 cases [50%]. Serum GH in both types of macradenoma was not significantly different [56 +/- 8ng/ml versus 59 +/- 8 ng/ml, respectively]. Serum prolactin level was high in 10 cases [38%] with a mean of 104 +/- 29 ng/ml. Preoperative defect in the field of vision was found in 10 cases. No case of central diabetes insipidus [CDI] was found at diagnosis in all patients. The outcome of surgery, in terms of postoperative GH less than 5 ng/ml, was zero%. After institution of external radiotherapy and bromocriptin therapy, 3 cases fulfilled the remission criteria after a 3 years' period. Those patients also, developed panhypopituitarism including TSH, ACTH and were given replacement thyroxine and cortisol treatment. Diabetes insipidus was found in the postoperative period in 14 cases [58%], but it vanished within one month in 12 cases and persisted in two patients. The number of patients with CDI rose to 4 [15%] with long term follow up. Pathology studies revealed eosinophil adenoma in 16 cases and chromophobe adenoma in 8 cases. Field of vision improved in 8 cases out of 10 patients with preoperative field defects. Serum postoperative prolactin level showed a significant decrease compared to the preoperative level in the 10 cases with high prolactin serum level, but only 3 cases reached the normal range. Conclusions: The poor outcome in acromegalic patients of the present series, inspite of the combined use of surgery, radiotherapy and medical treatment, is explained by the late diagnosis of the condition with higher prevalence of macroadenoma with extrasellar extensions, dispersion of operated patients among different neurosurgeons with different skills and experience, and lack of more effective drugs. Also, the relatively short period of follow up in relation to the delayed effects of radiotherapy adds to the poor results

Estudio y manejo de la hiperprolactinemia / Study and management of hyperprolactinemia

La hiperprolactinemia es una de las patologías que presenta mayor variedad de sintomatología, relacionada no sólo con la esfera gonadal y reproductiva, sino también con alteraciones en otros órganos efectores; ellos son: el sistema nervioso central, el inmunológico y el dermatológico, pudiendo presentarse, además, manifestaciones psicológicas. Su etiología es múltiple y variada, e incluye alteraciones dinámicas, funcionales y tumorales. La fisiopatología es compleja, debido a la multiplicidad de procesos bioquímicos y moleculares involucrados en este síndrome. El diagnóstico fluye de la evaluación clínica y el análisis de exámenes complementarios de laboratorio y de imágenes. El tratamiento depende de la causa subyacente y en la mayoría de los casos, los resultados son satisfactorios

Cavernous sinus invasion by pituitary macroadenomas

The classical imaging gold-standard for this diagnosis is the presence of tumor lateral to the carotid artery. Seventeen patients with pituitary macroadenomas with intraoperative confirmation of cavernous sinus invasion were studied with MRI. Only 8 patients had tumor lateral to the carotid artery; 13 had tumor within the carotid syphon and all lacked the ring enhancement of the medial wall of the cavernous sinus. In 10 patients, widening of the posterior double leaflets of the cavernous sinus could be. All patients were operated by the transephenoidal route. Only one patient was cured by surgery alone. Only 3 patients disclosing the above mentioned MRI features were identified in a series of 250 patients and did not have cavernous sinus invasion. The present criteria proved to be useful in the pre-operative diagnosis of cavenous sinus invasion and patients' counselling. Pre-operative diagnosis of cavernous sinus invasion of pituitary tumors has a great impact in the management of such patients.

Tratamiento de la Hiperprolactinemia en la mujer / Treatment of hyperprolactinemia in women

La hiperprolactinemia ocupa un lugar importante entre las causas de infertilidad, trastornos menstruales y galactorrea en la mujer, por ello nuestro interés en este trabajo fue presentar una revisión de las diferentes opciones terapéuticas de la hiperprolactinemia. Se plantea que la bromocriptina ha sido el medicamento de mayor uso y que actúa estimulando directamente los receptores dopaminérgicos D2 de las células hipofisarias. Se hace referencia a otros agonistas dopaminérgicos propuestos como lisurida, tergurida, metergolina, quinagolida, cabergolina, pergolida. Se destaca la relevancia clínica, por su buena tolerancia y actividad biológica sostenida, de la cabergolina y la quinagolida (CV-205-502). El riesgo tan reducido del crecimiento tumoral durante el embarazo en pacientes con microadenomas permite suspender el tratamiento con agonistas dopaminérgicos en cuanto se confirma el embarazo, pero se deberá reiniciar en caso de complicaciones neurológicas durante el mismo. Como conclusión, existe un consenso general de que el tratamiento medicamentoso es la primera opción en los pacientes con prolactinoma, la cirugía hipofisaria estaría indicada en pacientes según criterios muy seleccionados y el embarazo no está contraindicado en la mayoría de las pacientes

Macroprolactinoma como componente da síndrome de neoplasia endócrina múltipla tipo I / Macroprolactinoma how component of multiple endocrine neoplasm type I syndrome

Com o objetivo de discutir peculiaridades clínicas da neoplasia endócrina múltipla (NEM) do tipo 1 säo apresentados oito casos de uma família afetada, dos quais quatro se submetem a investigaçäo médica. Alguns aspectos clínicos se sobressaem nessa série, tais como: o macroprolactinoma em três casos foi o principal responsável pelas manifestaçöes da síndrome e em dois casos mostrou caráter invasivo; incidência maior no sexo masculino; a precocidade do surgimento dos sintomas (21 a 32 anos de idade) e possível ausência de comprometimento pancreático. A falta de comprometimento pancreático sugere que pode se tratar de uma variante incompleta da síndrome de NEM tipo 1, embora o acompanhamento pancreático seja necessário para se confirmar esta hipótese. A adenomectomia hipofisária foi realizada em dois casos, um dos quais faleceu em consequencia de recidiva tumoral e o controle dos níveis de prolactina foi obtido com bromocriptina no outro caso; bromocriptina foi a única terapeutica utilizada no terceiro paciente. Três pacientes realizaram paratiroidectomia total seguido de implante autólogo das paratireóides em dois deles. O implante manteve calcemia normal em ambos os casos. Recomenda-se repetidas determinaçöes de calcemia em todos os portadores de tumor hipofisário, como meio de identificar portadores de NEM do tipo 1

Macroprolactinoma resistente ao CV 205-502 / Macroprolactinoma resistent for the CV 205-502

Prolactinomas resistentes a agonistas dopaminérgicos sao raros. Descrevemos o caso de um paciente de 19 anos, masculino, portador de macroprolactinoma invasivo, nao responsivo tanto à bromocriptina (BCP) oral e injetável, como ao CV 205-502 (Sandoz, Suiça). O CV 205-502 é um novo agonista dopaminérgico D2 seletivo, nao derivado da ergotamina, 35 a 100 vezes mais potente que a BCP. O paciente foi encaminhado após craniotomia onde houve ressecçao parcial do tumor. A prolactina (PRL) pré-operatória era 1O.OOO ng/ml, e a tomografia mostrava adenoma hipofisário grau IV. Foi tratado com BCP oral (até 60 mg/dia) e depois com BCP injetável, permanecendo porém com níveis bastante elevados de PRL. Também nao houve reduçao do tumor. A seguir iniciou CV 205-502 (até O,300 mg/dia), com uma queda máxima dos níveis de PRL de 57 por cento (7.950 ng/ml). Contudo, as ressonâncias magnéticas pré e pós 53 dias da medicaçao mostraram um aumento do tumor. O paciente foi posteriormente submetido a duas cirurgias e encaminhado à radioterapia (RT). Catorze meses após a RT houve uma queda de 82 por cento nos níveis de PRL (de 11.900 para 2.199 ng/ml), e considerável reduçao tumoral. Em conclusao, além da ausência de normalizaçao da PRL, nosso paciente apresentou crescimento do tumor em vigência de agonistas dopaminérgicos, o que é extremamente raro.

Evolucion de prolactinomas en adolescentes / The course of prolactinomas in adolescents

Se presentan los resultados del tratamiento y seguimiento a mediano y largo plazo en 13 pacientes (8 niñas y 5 varones) de 14.2 a 20 años (x:16,5) portadores de prolactinoma. En el momento de la consulta los signos clínicos, más frecuentes fueron: cefaleas, detención o retraso de la pubertad, galactorrea y alteraciones visuales. La evaluación pretratamiento mostró respsuestas variables y discordantes de LH y FSH al ensayo de LH-RH, mientras que la prueba de TRH (TSH) resultó normal en 8/9 casos (una joven mostró un hipotiroidismo primario asociado). Los niveles de prolactina (PRL) basales estaban elevados en todos los casos entre 77 y 1150 ng/ml (x ñ SD : 378 ñ 285), sin incremento luego del TRH (x : 25%). En 8 casos, la cirugía constituyó el tratamiento inicial; 7 de ellos persistieron hiperprolactinémicos y requirieron bromocriptina (BEC) postquirúrgica. Cinco enfermos recibieron BEC como tratamiento primario; la TC mostró desaparición o importante reducción tumoral en 4 y ausencia de modificaciones en 1 niña por lo que se indicó cirugía secundariamente. La evolución pudo seguirse en 11 pacientes entre 2 y 12 años. De los operados inicialmente, 1 recuperó espontáneamente la función gonadal y 5 casos requirieron tratamiento complementario. De los 5 casos tratados primariamente con BEC, una recuperó ciclos espontáneamente logrado embarazo a los 10 meses, una completó el desarrollo puberal y presenta sangrados periódicos, una requirió tratamiento complementario con progesterona y el varón recuperó la función gonadal. La niña que fue secundariamente operada persiste normoprolactinémia sin recuperar sus ciclos. Concluimos que: 1) la PRL basal, junto con la evaluación radiológica, constituyen los elementos fundamentales en el diagnóstico de prolactinoma; 2) las evidencias clínicas y radiológicas abonarían en favor de una mayor rapidez evolutiva en los varones; 3) la BEC constituye un recurso valioso en el tratamiento primario o complementario de los prolactinomas en pacientes infantojuveniles

Adenomas prolactínicos en mujeres menores de 20 años: a proposito de once casos / Prolactin adenomas on women under 20: report of 11 cases

Son analizados los aspectos clínicos, neuroendocrinos, terapéuticos y evolutivos de 11 pacientes del sexo femenino, portadoras de síndrome de amenorrea galactorrea, con inicio de síntomas en edad puberal y diagnóstico etiológico de adenoma prolactínico, cuya terapéutica neuroquirúrgica fue realizada en edades comprendidas entre 16 y 20 años. Es importantes su presentación pues: 10 la mayoria de estas pacientes fueron consideradas y tratadas inicialmente como portadora de trastornos "fisiológicos" del ciclo sexual compatibles con la edad, y 2) por la alta frecuencia de macroadenomas prolactínicos con expansión extraselar encontrados (3/11 casos, 27%), lo que trae como consecuencia, resección quirúrgica incompleta y pronóstico reservado. Las características principales de este grupo, fueron: 1) rítmo circadiano de PRL patológico, pruebas de TRH y MCP patológicas (100, 80 y 100%, respectivamente); 2) radiografías simples, politomografía lineal y tomografía axial computada de silla turca patológicas (73%, y 100% respectivamente); 3) terapéutica neuroquirúrgica por vía transepto esfenoidal en 10 casos y por vía subfrontal en un caso, y 4) evolución espontánea hacia la recuperación de ciclos sexuales en lapsos de 1 a 4 meses en aquellas pacientes operadas de adenomas intraselares, y persistencia del síndrome de amenorrea galactorrea en las pacietnes operadas de macroadenomas expansivos. El diagnóstico precoz (basado en los datos clínicos, bioquímicos y neurorradiólógicos) que orienta hacia la terapéutica neuroquirúrgica cuando el adnoma hipofisario es aúm intraselar, se acompaña de los mejores resultados evoluticos post-quirúrgicos