Reconsideration of Surgical Indication for Prolactin-producing Pituitary Tumor Focusing on Visual Impairment
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- AMANO Kosaku
- Department of Neurosurgery, Tokyo Women's Medical University
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- ODA Yuichi
- Department of Neurosurgery, Tokyo Women's Medical University
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- SEKI Yasufumi
- Department of Endocrinology and Hypertension, Tokyo Women's Medical University
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- YAMASHITA Kaoru
- Department of Endocrinology and Hypertension, Tokyo Women's Medical University
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- BOKUDA Kanako
- Department of Endocrinology and Hypertension, Tokyo Women's Medical University
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- ICHIHARA Atsuhiro
- Department of Endocrinology and Hypertension, Tokyo Women's Medical University
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- KAWAMATA Takakazu
- Department of Neurosurgery, Tokyo Women's Medical University
抄録
<p>Prolactin-producing pituitary tumor (PRLoma) is the most prevalent functional pituitary tumor. If the tumor becomes large, vision can be impaired. In contrast to other pituitary tumors, cabergoline (CAB) is extremely effective for PRLoma and has become the first-line treatment. In this study, we examined our experience with the pharmacological and surgical management of PRLomas with visual impairment (VI) to determine whether VI could be a surgical indication. Further, we discussed the function of surgery in situations where the gold standard of PRLoma treatment was CAB administration. Of the 159 patients with PRLomas (age, 13-77 [mean = 36.3] years; men, 29; women, 130) at Tokyo Women's Medical University Hospital from 2009 to 2021, 18 (age, 15-67 [mean = 35.8] years; men, 12; woman, 6) had VI (subjectively, 12; objectively, 6). They started CAB treatment immediately (maximum dose: 0.5 to 6 mg/week; average: 2.17 mg/week). VI improved in 16 patients (88.9%) but did not improve in 2 (11.1%) requiring surgeries. One of the two patients had a parenchymal tumor resistant to CAB, and the other had a cystic tumor due to intratumoral bleeding. Consequently, CAB is the first-line treatment for PRLomas with VI because of its significantly high rate of improvement. However, close and rigorous surveillance is necessary for cases resistant to CAB, and the correct decision is required regarding surgical interventions at proper timing and appropriate surgical approaches considering the purpose of surgery.</p>
収録刊行物
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- Neurologia medico-chirurgica
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Neurologia medico-chirurgica 64 (4), 160-167, 2024-04-15
一般社団法人 日本脳神経外科学会