Öz
Amaç:
Kliniğimizdeki agresif seyirli prolaktinoma olgularının tedavi sonuçları ve
tedavi yöntemleri retrospektif olarak değerlendirildi. Buna benzer olgularda en
uygun takip ve tedavi stratejilerinin belirlenebilmesi amaçlandı.
Hastalar ve Yöntem:
Bu çalışmamızda, 2004-2013 yılları arasında endokrinoloji kliniği’mizde arşive
kayıtlı hipofiz konseyinde multidisipliner yaklaşımla izlenen vakaların
verileri retrospektif olarak incelendi. Hastalar medikal tedavi ile remisyon,
cerrahi ile remisyon, cerrahi sonrası medikal tedavi ile remisyon, ilaç
dirençleri, cerrahi ve medikal tedavi sonrası tümörde progresyon sonrası ikinci
cerrahi olarak sınıflandırıldı.
Bulgular:
Araştırmaya toplam 65 hasta alındı. Hastaların %61.5 (n=40) kadın, %38.4 (n=25)
erkek idi. Toplam olgular % 60 mikroadenom, % 40 makroadenom olarak ikiye
ayrıldı. Olgulardan 37 kişi medikal, 7 kişi cerrahi, 17 hastaya cerrahi sonrası
medikal tedavi uygulanmıştı. Mikroadenom nedeniyle takip edilen olgulardan
%69.4’ü medikal tedavi ile, %8.3’ü cerrahi tedavi ile, %8.3’ü cerrahi sonrası
medikal tedavi ile remisyon sağlanmıştı. Makroadenom nedeniyle takip edilen 25
olgudan %20 medikal tedavi ile, %16 cerrahi tedavi ile, %48 cerrahi sonrası
medikal tedavi ile remisyon sağlandığı saptandı. Olgularda ortalama direnç
%11.4 olarak saptandı.
Sonuç:
Prolaktinoma benign karakterine rağmen tedavisi güç bir hipofiz tümörüdür.
Medikal tedavi yanıtlarımız literatür ile benzer olmasına rağmen cerrahi
operasyon sıklığımız literatürden daha fazla saptandı. Bu durum çalışmaya ağresif seyirli olguların alınması ile
açıklanmaktadır.
Anahtar Kelimeler
Kaynakça
- 1. Daly AF, Tichomirowa MA, Beckers A. The epidemiology and genetics of pituitary adenomas. Best Pract Res Clin Endocrinol Metab 2009;23(5):543-554.
- 2. Rosato F, Garofalo P. Hyperprolactinemia: from diagnosis to treatment. Minerva Pediatr 2002;54:547-52.
- 3. Naliato EC, Violante AH, Caldas D, Lamounier Filho A, Loureiro CR, Fontes R, et al. Body fat in nonobese women with prolactinoma treated with dopamine agonists. Clin Endocrinol 2007;67(6):845-52.
- 4. Yavuz D, Deyneli O, Akpinar I, Yildiz E, Gözü H, Sezgin O, et al. Endothelial function, insulin sensitivity and inflammatory markers in hyperprolactinemic pre-menopausal women. Eur J Endocrinol 2003;149(3):187-93.
- 5. Melmed S, Casanueva FF, Hoffman AR, Kleinberg DL, Montori VM, Schlechte JA, et al. Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2011;96(2):273-88.
- 6. De Rosa M, Zarrilli S, Di Sarno A et al. Hyperprolactinemia in men: clnical and biochemical features and response to treatment. Endocrine 2003;20(1-2):75-82.
- 7. Dos Santos Nunes V, El Dib R, Boguszewski CL, Nogueira CR. Cabergoline versus bromocriptine in the treatment of hyperprolactinemia: a systematic review of randomized controlled trials and metaanalysis. Pituittary 2011;14(3):259-65.
- 8. Colao A, Vitale G, Cappabianca P, Briganti F, Ciccarelli A, De Rosa M, Zarrilli S, Lombardi G. Outcome of cabergoline treatment in men with prolactinoma: Effects of a 24-month treatment on prolactin levels, tumor mass, recovery of pituitary function, and semen analysis. J Clin Endocrinnol Metab 2004;89:1704-1711.
- 9. Oh MC, Aghi MK. Dopamine agonist-resistant prolactinomas. J Neurosurg 2011;114(5):1369-79.
- 10. Colao A, Savastano S. Medical treatment of prolactinomas. Nat Rev Endocrinol 2011;7(5):267-78.
- 11. Gillam MP, Molitch ME, Lombardi G, Colao A. Advances in the treatment of prolactinomas. Endocr Rev 2006;27(5):485-534.
- 12. Colao A, Savastano S. Medical treatment of prolactinomas. Nat Rev Endocrinol 2011;7(5):267-78.
Öz
Aim: In the
present study, the treatment results and treatment methods of the patients who
had aggressive-progressing prolactinoma in our clinic were evaluated
retrospectively. The purpose was to identify the most appropriate follow-up and
treatment strategies in similar cases.
Patients and Methods: In this study of ours, the data recorded in our
endocrinology clinic between 2004 and 2013 out of the patients, who were
followed-up in our clinic with a multidisciplinary approach in Hypophysis
Council, were examined retrospectively. The patients were classified as
Remission with Medical Treatment, Remission with Surgery, Remission with
Medical Treatment After Surgery, Drug Resistance, and Surgery and “Second
Surgery after Tumor Progression after Medical Treatment.
Results: A
total of 65 patients were included in the study. A total of 61.5% (n=40) of the
patients were female; and 38.4% (n=25) were male. All of the cases were divided
into two as 60% with microadenomas and 40% with macroadenomas. 37 cases
received medical treatment, 7 patients received surgery, and 17 patients
received medical treatment after surgery. A total of 69.4% of the patients, who
were followed up due to microadenoma, had remission with medical treatment;
8.3% had remission with surgical treatment; and 8.3% had remission with medical
treatment after surgery. It was determined that 20% of the 25 patients, who
were followed-up due to macroadenoma, had remission with medical treatment; 16%
had remission with surgical treatment; and 48% had remission with medical
treatment after surgery. The average resistance in the cases was 11.4%.
Conclusion:
Despite its benign nature, prolactinoma is a hypophysis tumor with difficult
treatment. Although the medical treatment responses in our study were
compatible with existing literature, the prevalence of the surgical operation
in our study was found to be more when compared to existing literature. This
situation may be explained with the fact that the patients with aggressive
progression were included in the present study of ours.
Anahtar Kelimeler
Kaynakça
- 1. Daly AF, Tichomirowa MA, Beckers A. The epidemiology and genetics of pituitary adenomas. Best Pract Res Clin Endocrinol Metab 2009;23(5):543-554.
- 2. Rosato F, Garofalo P. Hyperprolactinemia: from diagnosis to treatment. Minerva Pediatr 2002;54:547-52.
- 3. Naliato EC, Violante AH, Caldas D, Lamounier Filho A, Loureiro CR, Fontes R, et al. Body fat in nonobese women with prolactinoma treated with dopamine agonists. Clin Endocrinol 2007;67(6):845-52.
- 4. Yavuz D, Deyneli O, Akpinar I, Yildiz E, Gözü H, Sezgin O, et al. Endothelial function, insulin sensitivity and inflammatory markers in hyperprolactinemic pre-menopausal women. Eur J Endocrinol 2003;149(3):187-93.
- 5. Melmed S, Casanueva FF, Hoffman AR, Kleinberg DL, Montori VM, Schlechte JA, et al. Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2011;96(2):273-88.
- 6. De Rosa M, Zarrilli S, Di Sarno A et al. Hyperprolactinemia in men: clnical and biochemical features and response to treatment. Endocrine 2003;20(1-2):75-82.
- 7. Dos Santos Nunes V, El Dib R, Boguszewski CL, Nogueira CR. Cabergoline versus bromocriptine in the treatment of hyperprolactinemia: a systematic review of randomized controlled trials and metaanalysis. Pituittary 2011;14(3):259-65.
- 8. Colao A, Vitale G, Cappabianca P, Briganti F, Ciccarelli A, De Rosa M, Zarrilli S, Lombardi G. Outcome of cabergoline treatment in men with prolactinoma: Effects of a 24-month treatment on prolactin levels, tumor mass, recovery of pituitary function, and semen analysis. J Clin Endocrinnol Metab 2004;89:1704-1711.
- 9. Oh MC, Aghi MK. Dopamine agonist-resistant prolactinomas. J Neurosurg 2011;114(5):1369-79.
- 10. Colao A, Savastano S. Medical treatment of prolactinomas. Nat Rev Endocrinol 2011;7(5):267-78.
- 11. Gillam MP, Molitch ME, Lombardi G, Colao A. Advances in the treatment of prolactinomas. Endocr Rev 2006;27(5):485-534.
- 12. Colao A, Savastano S. Medical treatment of prolactinomas. Nat Rev Endocrinol 2011;7(5):267-78.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | İç Hastalıkları |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Yayımlanma Tarihi | 13 Kasım 2018 |
| Gönderilme Tarihi | 4 Mayıs 2018 |
| Kabul Tarihi | 31 Ağustos 2018 |
| Yayımlandığı Sayı | Yıl 2018 Cilt: 2 Sayı: 3 |
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