Prolactin as a predictor of neuroendocrine recovery after transsphenoidal tumor removal in patients with pituitary apoplexy

Abstract

Introduction. The risk of pituitary apoplexy is 5.4 times higher than the risk of hemorrhage into another intracranial tumor. Despite the fact that in 80 % of cases, hemorrhage into the pituitary adenoma is the first manifestation of the disease, the issues of neuroendocrine recovery, evaluation of the results of surgical treatment are insufficiently studied at present.Methods and materials. A clinical study of 72 patients with histologically confirmed diagnosis of pituitary adenoma was conducted. According to MRI of the brain with intravenous contrast, neuroimaging signs of pituitary apoplexy were found in all the studied patients. The studied patients were aged from 28 to 55 years, the average age of patients was 48.9±15.25 years (median 49 years). All the examined patients underwent surgical treatment – transsphenoidal endoscopic removal of pituitary adenoma; there were no emergency indications for surgical treatment among the examined patients. In the preop- erative and late postoperative periods, the relationship between the values of prolactin and other pituitary hormones with the parameters of neuroendocrine recovery was evaluated.Results. In patients with recurrent pituitary adenoma and pituitary apoplexy, suprasellar (χ2=8; r=0.005) and laterosellar growth (χ2=3.92; r=0.048) are significantly less common; reduced prolactin and ACTH values are more often detected after surgical treatment (p<0.05). It was revealed that with preoperative increased prolactin indices, general cerebral symptoms (r=–1; p=0) and visual disturbances (r=–0.982; p=0.28) are less common after surgery. In patients with ACTH-secreting pituitary adenoma after apoplexy, the totality of removal of Near Complete Gross Resection was more often observed (r=0.382; p=0.004).Conclusion. In patients with pituitary apoplexy before surgery, an increased prolactin index is one of the markers of regression of hypopituitary disorders in the postoperative period.