Enlarged adenomectomy for enclosed prolactinomas: A preliminary study of 26 cases

Abstract

Preliminary results obtained from 26 cases of prolactinomas less than 20 mm in diameter after treatment by enlarged adenomectomy are described. The operation consisted in removal of the adenoma, a layer of normal pituitary at the outer edge of the tumour and the pituitary capsule in contact with the sellar meninges. 24 women and 2 men were involved whose prolactin levels (PRL) were less than 200 ng/ml. All presented abnormal PRL responses to Thyrotropin releasing hormone (TRH) and Metoclopramide (MCP) tests and an absence of a nocturnal rise in the sleep cycle study. Postoperatively, three patients developed transitory diabetes insipidus and five transitory adrenal insufficiency. Gonadotropin reserve was always found normal. All 24 women resumed normal menstrual cycles and two became pregnant within one year. From a serological viewpoint, after surgery 100% of patients were found to be normal for levels of prolactin but only 85% turned to normal dynamic tests. The results of this small series of enlarged adenomectomies seem better than those obtained using selective adenomectomy, but must be confirmed with time.

Markers of tumor invasion are major predictive factors for the long-term outcome of corticotroph microadenomas treated by transsphenoidal adenomectomy

“…Moreover, extension of tumoral tissue into the peritumoral rim in patients in remission suggests that removal of macroscopically normal pituitary tissue around the visible lesion might have been beneficial in these patients. Similar observations have been made in other types of pituitary adenomas (21). Unlike other authors (7), we found no evidence of corticotroph hyperplasia in the specimens analyzed.…”

“…An enlarged adenomectomy, removing the adenoma and the surrounding parenchyma, was performed as described previously (21). Before the adenoma was sought or penetrated, the two lateral wings were dissected, the surgeon keeping the approach outside the capsule.…”

“…In this respect, a surgical strategy characterized by a deliberate attempt at performing a curative removal of the tumor by the same experienced neurosurgeon (F G) was chosen. On the assumption that unsuccessful surgical removals were accounted for by insufficient adenomectomy because of the presence of tumoral cells at the periphery of the adenoma, an enlarged adenomectomy was carried out (21).…”