Prolactin‐Secreting pituitary tumors

Abstract

Prolactin secretion was evaluated in 69 patients with pituitary tumors. Among the 47 w h o were seen prior to treatment, hyperprolactinemia was present in 37 (79%). Excluding patients with galactorrhea, hyperprolactinemia was present in 19 (70%) of those seen before treatment. T h e r e was little correlation between tumor size and level of serum prolactin. Both transsphenoidal surgery and radiotherapy greatly reduced the hyperprolactinemia, b u t a more rapid decrease was achieved with microsurgical removal of the secreting adenoma. We have reviewed a series of patients with pituitary tumors in whom serum prolactin was determined in order to find the incidence of prolactin-secreting pituitary tumors and to determine their biological profile. The series contained large tumors causing chiasmal compression as well as small, hypersecreting microadenomas. In addition, we evaluated the clinical response of these patients to a variety of therapeutic modalities. Clinical Material and MethodsProlactin secretion was evaluated in 69 patients with pituitary tumors seen between 1971 and 1975. There were 28 men and 41 women, with ages rangingfrom 16 to 75 (mean, 40.6) years. Visual field defects were present in 33 patients (18 ofwhom had hyperprolactinemia). Five patients also had compromise of the third or sixth cranial nerves or both, indicating lateral extension of the tumor. Galactorrhea was documented by history or clinical examination in 2 1 women; in 2 of them this started in the postpartum period. Nineteen patients with galactorrhea also had amenorrhea, which was of the primary type in 2 of them. In addition, 7 women had amenorrhea without galactorrhea. Two men had galactorrhea and decreased libido. Ten patients had clinical and chemical evidence of acromegaly. The diagnosis of pituitary tumor was confirmed histologically in 50 cases. In the remaining 19 patients the diagnosis was based on the presence of clinical and laboratory evidence of pituitary dysfunction associated with an eniarged sella turcica.Pneumoencephalography, cerebral angiography, or both were performed in all patients to determine the extension of tumor. Prolactin, growth hormone, luteinizing hormone (LH), FSH, thyroxine, and in some cases triiodothyronine were measured by radioimmunoassay. Adrenal function was evaluated by measuring the serum levels of cortisol before and after stimulation with adrenocortico-tropic hormone. The urinary excretion of 17-ketogenic steroids and 17 ketosteroids was also measured. In a few cases response of prolactin to the following agents was assessed: thyrotropin-releasing hormone (TRH), given as a 500 pg bolus intravenously; L-dopa, 500 mg orally; and chlorpromatine, 50 mg intramuscularly. Results Endocrine FindingsProlactin was measured prior to treatment in 47 patients and was elevated in 37 (79%) (normal values: men, 0-20 ng/ml; women, 1-25 ng/ml) (Fig 1). Abnormal Ievels ranging from 2 1 to 10,000 nglml were found in 15 men (79%; mean value, 1,646 ng/ml). Increased prolactin levels were found in 22 women (79%), wi...

The value of an intravenous TRH test for the diagnosis of tumoural prolactinaemia

“…Thus, a 20 min Prl response after 200 ug TRH higher than 3.5 times the basal level was never observed in our tumour patients and only 5 out of 42 patients (12%) showed a peak level higher than 2 times the basal level (R2 > 1). This is again in accordance with the results re¬ ported by others; irrespective of the dose of TRH used, the response of tumour patients does not exceed the 3.5 times basal value Snyder et al 1974;Zarate et al 1975;Jacobs et al 1976;Glass et al 1976;Fossati et al 1976;Kletzky et al 1977;Kleinberg et al 1977;Lobo Antunes et al 1977;Corbey et al 1977;Samaan et al 1977;Silvestrini et al 1978;Cowden et al 1979;Jeske 1979). Only Lamberts et al (1976) observed in 4 out of 24 patients a higher response; however, these authors used a higher (400 ug) dosage of TRH, which may have caused a greater response.…”

Advances in the Treatment of Prolactinomas

“…Although symptoms of hypogonadism are still the most prevalent, symptoms due to mass effects commonly serve as those that prompt medical attention and lead to the diagnosis. A summary of 16 series comprising 444 men with prolactinomas indicates that 77.9% were impotent, 36.6% had visual field defects, 33.8% had partial or complete hypopituitarism, 29.1% complained of headaches, and only 10.9% had galactorrhea (60, 64,75,85,114,115,[431][432][433][434][435][436][437][438][439][440][441]. Thus, about one third of men have symptoms due to tumor size.…”

Recurrence of chromophobe pituitary adenomas after operation and postoperative radiotherapy

“…Nevertheless, the size of the tumor, regardless of whether functioning or not, is obviously one of the most important determining factors of the overall cure rate ( Antunes et al 1977, Chang et al 1977, Hardy et al 1978, Jaquet et al 1978, Tindal et al 1978, Derome et al 1979, Murray et al 1979, Post et al 1979, Pelkonen et al 1981. Nevertheless, the size of the tumor, regardless of whether functioning or not, is obviously one of the most important determining factors of the overall cure rate ( Antunes et al 1977, Chang et al 1977, Hardy et al 1978, Jaquet et al 1978, Tindal et al 1978, Derome et al 1979, Murray et al 1979, Post et al 1979, Pelkonen et al 1981.…”