Problems in the management of large prolactin-secreting pituitary adenomas

To determine current problems in the management of large prolactin-secreting pituitary adenomas. Retrospective study of consecutive patients with prolactin-secreting adenomas over a 10 years period. Neurosurgical division of King Khalid University Hospital, Riyadh, Saudi Arabia. Thirty-one patients four with microadenomas and 27 with macroprolactinomas. Tumour resection was performed in 22 patients: transsphenoidal in 16 and transcranial in six patients were treated conservatively [dopamine agonist alone in five cases, and combined with radiotherapy in one]. Three patients refused surgery and were excluded. Surgical morbidity and mortality, postoperative basal prolactin level. Six patients [27%] became normoprolactinaemic directly after surgery; 14 patients required additional postoperative treatment. The overall rate of return of serum prolactin level to normal at last follow up was 71%. Hyperprolactinaemia was significantly reduced in a further 21% of the patients while the remaining 8% were unchanged. One patients died 40 days after transcranial surgery. Two patients developed tumour recurrences and hyperprolactinaemia relapsed in a third patient with no evidence of tumour regrowth. The failure rate of monotherapy in large prolactin-secreting adenomas is high. At present, the combination of transsphenoidal surgery and dopamine agonist therapy provides the highest control rates of the tumour and the associated hyperprolactinaemia

Observations on the pattern of pituitary adenomas in a major neurosurgical unit in Saudi Arabia

A hospital-based series of 83 consecutive patients [42 Saudis and 41 non-Saudis] with pituitary adenomas from Riyadh, Saudi Arabia was retrospectively analyzed. While the demographic and clinical features were not different from those reported previously, this series differed from most other series in the following aspects: [1] Nonsecreting adenoma was the prevailing type; [2] the percentage of microadenoma was comparatively low; [3] There were more men than women with prolactinomas. These differences could have resulted from an unusually low number of Saudi women with prolactin secreting microadenoma. The relative frequency of growth hormone secreting adenomas was significantly lower in Saudis than non-Saudis [4.8% versus 36.6%]. Yemeni patients in this series showed a specially high incidence of acromegaly [57%]. Our findings suggest that some regional and probably ethnic variations may exist in the pattern of pituitary adenoma

Surgical management of Chiari malformation and syringomyelia: experience in 14 cases

Our experience with 14 patients afflicted with symptomatic Chiari malformation and syringomyelia, who were treated at King Khalid University Hospital between 1983 and 1990, is analyzed with reference to presentation, management, operative findings, and outcome. Patients with associated myelomeningocele, tethered cord, and spinal cord tumors were excluded from this series. The wide variations in natural history and clinical findings are emphasized. Neuroradiological studies included plain roentgenograms, myelograms, metrizamide-enhanced computed tomograms, and more recently magnetic resonance imaging scans. Posterior fossa decompression was the standard operation; other surgical procedures included syringosubarachnoid shunt, ventriculoperitoneal shunt, transoral odontoid resection, and terminal ventriculostomy. Four patients experienced definite improvement following surgery; the condition in seven was unchanged, and three suffered worsening of the disorder despite operation