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d i s c u s s i o n
Pituitary Adenoma
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Pituitary Adenoma | ||
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Related narrative: Transsphenoidal Resection of Pituitary Prolactinoma Prolactinoma is a common (~40% of pituitary adenomas), usually benign (rare metastatic disease has been reported) adenoma of the adenohypophysis. Galactorrhea is a rare presentation in a man. Impotence, infertility and gynecomastia (15%) may also occur. Therapeutic issues in women relate to fertility. Microadenomas (<1cm) are commonly treated with medical therapy (boromcryptine, dopamine agonists) with reduction or stability in the size of the adenoma. Return of elevated prolactin levels usually ensues after cessation of therapy. The morbidity of prolactinoma results from mass effect and compression of adjacent structures. This, and avoidance of long term medical therapy may mitigate for surgical resection of the adenoma. Transsphenoidal selective adenectomy is the procedure of choice for small lesions because of the minimal morbidity compared with craniotomy. The adenoma is usually easily identified as soft, gray tissue compared to the firm yellow/orange normal gland. It often liquefies on manipulation and oozes out of the pituitary fossa. Microadenomas may be embedded in the substance of the gland and require incision to expose. If prolactin levels remain normal after resection, there is a 15% recurrence rate. References: Wells, SA and Santen, RJ in Sabiston, Textbook of Surgery, WB Saunders, 13th ed, 1986, pp. 639-652 Molitch ME, Medical treatment of prolactinomas, Endocrinol Metab Clin North Amer, 1999 Mar; 28(1):143-169. Gsponser J, Diagnosis, treatment and outcome of pituitary tumors and other intrasellar masses. retrospective analysis of 353 cases, J Medicine (Baltimore), 1999 Jul; 78(4): 236-269. Hurel S, et al, Metastatic prolactinoma, J Clin Endocr & Metab, 1997 May 81(5): 1711-1719.
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