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Erschienen in: Pituitary 1/2008

01.03.2008

Five years follow-up of invasive prolactinomas with special reference to the control of cavernous sinus invasion

verfasst von: Zhe Bao Wu, Zhi Peng Su, Jin Sen Wu, Wei Ming Zheng, Qi Chuan Zhuge, Ming Zhong

Erschienen in: Pituitary | Ausgabe 1/2008

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Abstract

Background Few data are presently available on the effective control of cavernous sinus (CS) invasion of invasive prolactinomas. The aim of this retrospective study, through a mean period of 5 years follow up, is to observe the tumor shrinkage of CS invasive prolactinomas, as well as PRL normalization with bromocriptine therapy. Methods 68 patients met the criteria of invasive prolactinomas (Grade III or IV in the classification scheme of Knosp and colleagues; serum PRL level greater than 200 ng/ml). 33 patients underwent bromocriptine therapy as the initial treatment, and 14 of these 33 had combined treatment with microsurgery and/or radiotherapy. The other 35 patients received microsurgery as the primary treatment, after which two patients had normal PRL without taking bromocriptine and other 33 patients received bromocriptine treatment after microsurgery. Results Tumor volume on magnetic resonance images had completely disappeared in 50 patients (74%), while all the other 18 patients had residual tumor in the parasellar areas, invading the CS, and 14 patients had a secondary empty sella due to tumor shrinkage. Of those 14 patients, seven still had elevated PRL levels; five had optic chiasmal herniation by different degrees (P < 0.05). There were 49 patients with normal PRL levels (72%); five patients with PRL levels more than 200 ng/ml. After the treatment, 14 patients with tumor volume disappearance on MR images and PRL normalization therefore withdrew from bromocriptine therapy. During a subsequent one-and-a-half-year follow-up, tumor recurrence and PRL increase were not found in those 14 patients. Twenty-seven patients maintained normal PRL levels with low-dose bromocriptine, of which 20 patients had their tumor disappear while seven patients had CS residual tumor. Conclusions About three-fourths of prolactinomas with CS invasion can be effectively controlled not only with regard to tumor volume disappearance but also in serum PRL normalization. Residual tumor in the CS areas with PRL normalization and no pressure symptoms can be treated with low-dose of bromocriptine so as to achieve long-term tumor volume control and endocrine control. Great attention should be paid to CS residual tumors accompanying the empty sella, especially in cases with optic chiasmal herniation.
Literatur
1.
Zurück zum Zitat Cottier JP, Destrieux C, Brunereau L et al (2000) Cavernous sinus invasion by pituitary adenoma: MR imaging. Radiology 215:463–469PubMed Cottier JP, Destrieux C, Brunereau L et al (2000) Cavernous sinus invasion by pituitary adenoma: MR imaging. Radiology 215:463–469PubMed
2.
Zurück zum Zitat Knosp E, Steiner E, Kitz K et al (1993) Pituitary adenomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings. Neurosurgery 33:610–618PubMedCrossRef Knosp E, Steiner E, Kitz K et al (1993) Pituitary adenomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings. Neurosurgery 33:610–618PubMedCrossRef
3.
Zurück zum Zitat Wu ZB, Yu CJ, Su ZP et al (2006) Bromocriptine treatment of invasive giant prolactinomas involving the cavernous sinus: results of a long-term follow up. J Neurosurg 104(1):54–61PubMedCrossRef Wu ZB, Yu CJ, Su ZP et al (2006) Bromocriptine treatment of invasive giant prolactinomas involving the cavernous sinus: results of a long-term follow up. J Neurosurg 104(1):54–61PubMedCrossRef
4.
Zurück zum Zitat Delgrange E, Sassolas G, Perrin G, et al (2005) Clinical and histological correlations in prolactinomas, with special reference to bromocriptine resistance. Acta Neurochirurgica (Wien) 147:751–758CrossRef Delgrange E, Sassolas G, Perrin G, et al (2005) Clinical and histological correlations in prolactinomas, with special reference to bromocriptine resistance. Acta Neurochirurgica (Wien) 147:751–758CrossRef
5.
Zurück zum Zitat Delgrange E, Duprez T, Maiter D (2006) Influence of parasellar extension of macroprolactinomas defined by magnetic resonance imaging on their responsiveness to dopamine agonist therapy. Clin Endocrinol 64:456–462CrossRef Delgrange E, Duprez T, Maiter D (2006) Influence of parasellar extension of macroprolactinomas defined by magnetic resonance imaging on their responsiveness to dopamine agonist therapy. Clin Endocrinol 64:456–462CrossRef
6.
Zurück zum Zitat Laws ER Jr, Thorner MO, Vance ML (1996) Bromocriptine therapy for prolactin-secreting pituitary adenomas. Neurosurg Focus 1(1):E4PubMedCrossRef Laws ER Jr, Thorner MO, Vance ML (1996) Bromocriptine therapy for prolactin-secreting pituitary adenomas. Neurosurg Focus 1(1):E4PubMedCrossRef
7.
Zurück zum Zitat Colao A, Di-Sarno A, Landi ML et al (1997) Long-term and low-dose treatment with cabergoline induces macroprolactinoma shrinkage. J Clin Endocrinol Metab 82(11):3574–3579PubMedCrossRef Colao A, Di-Sarno A, Landi ML et al (1997) Long-term and low-dose treatment with cabergoline induces macroprolactinoma shrinkage. J Clin Endocrinol Metab 82(11):3574–3579PubMedCrossRef
8.
Zurück zum Zitat Essais O, Bouguerra R, Hamzaoui J et al (2002) Efficacy and safety of bromocriptine in the treatment of macroprolactinomas. Ann Endocrinol (Paris) 63(6 Pt 1):524–531 Essais O, Bouguerra R, Hamzaoui J et al (2002) Efficacy and safety of bromocriptine in the treatment of macroprolactinomas. Ann Endocrinol (Paris) 63(6 Pt 1):524–531
9.
Zurück zum Zitat Shrivatava RK, Arginteanu MS, King WA et al (2002) Giant prolactinomas: clinical management and long-term follow up. J Neurosurg 97:299–306 Shrivatava RK, Arginteanu MS, King WA et al (2002) Giant prolactinomas: clinical management and long-term follow up. J Neurosurg 97:299–306
10.
Zurück zum Zitat Yu C, Wu Z, Gong J (2005) Combined treatment of invasive giant prolactinomas. Pituitary 8(1):61–65PubMedCrossRef Yu C, Wu Z, Gong J (2005) Combined treatment of invasive giant prolactinomas. Pituitary 8(1):61–65PubMedCrossRef
11.
Zurück zum Zitat Couldwell WT, Weiss MH, Rabb C et al (2004). Variations on the standard transsphenoidal approach to the sellar region, with emphasis on the extended approaches and parasellar approaches: surgical experience in 105 cases. Neurosurgery 55:539–550PubMedCrossRef Couldwell WT, Weiss MH, Rabb C et al (2004). Variations on the standard transsphenoidal approach to the sellar region, with emphasis on the extended approaches and parasellar approaches: surgical experience in 105 cases. Neurosurgery 55:539–550PubMedCrossRef
12.
Zurück zum Zitat Losa M, Mortini P, Barzaghi R et al (2002) Surgical treatment of prolactin-secreting pituitary adenomas: early results and long-term outcome. J Clin Endocrinol Metab 87:3180–3186PubMedCrossRef Losa M, Mortini P, Barzaghi R et al (2002) Surgical treatment of prolactin-secreting pituitary adenomas: early results and long-term outcome. J Clin Endocrinol Metab 87:3180–3186PubMedCrossRef
13.
Zurück zum Zitat Sieck JO, Niles NL, Jinkins JR et al (1986) Extrasellar prolactinomas: successful management of 24 patients using bromocriptine. Horm Res 23(3):167–176PubMed Sieck JO, Niles NL, Jinkins JR et al (1986) Extrasellar prolactinomas: successful management of 24 patients using bromocriptine. Horm Res 23(3):167–176PubMed
14.
Zurück zum Zitat van’t Verlaat JW, Croughs RJ, Hendriks MJ et al (1990) Results of primary treatment with bromocriptine of prolactinomas with extrasellar extension. Can J Neurol Sci 17(1):71–73 van’t Verlaat JW, Croughs RJ, Hendriks MJ et al (1990) Results of primary treatment with bromocriptine of prolactinomas with extrasellar extension. Can J Neurol Sci 17(1):71–73
15.
Zurück zum Zitat Delgrange E, Maiter D, Donckier J (1996) Effects of the dopamine agonist cabergoline in patients with prolactinoma intolerant or resistant to bromocriptine. Eur J Endocrinol 134:454–456PubMed Delgrange E, Maiter D, Donckier J (1996) Effects of the dopamine agonist cabergoline in patients with prolactinoma intolerant or resistant to bromocriptine. Eur J Endocrinol 134:454–456PubMed
16.
Zurück zum Zitat Verhelst J, Abs R, Maiter D et al (1999) Cabergoline in the treatment of hyperprolactinemia: a study in 455 patients. J Clin Endocrinol Metab 84(7):2518–2522PubMedCrossRef Verhelst J, Abs R, Maiter D et al (1999) Cabergoline in the treatment of hyperprolactinemia: a study in 455 patients. J Clin Endocrinol Metab 84(7):2518–2522PubMedCrossRef
17.
Zurück zum Zitat Fraioli B, Esposito V, Santoro A et al (1995) Transmaxillosphenoidal approach to tumors invading the medial compartment of the cavernous sinus. J Neurosurg 82:63–69PubMedCrossRef Fraioli B, Esposito V, Santoro A et al (1995) Transmaxillosphenoidal approach to tumors invading the medial compartment of the cavernous sinus. J Neurosurg 82:63–69PubMedCrossRef
18.
Zurück zum Zitat Frank G, Pasquini E (2006) Endoscopic endonasal cavernous sinus surgery, with special reference to pituitary adenomas. Front Horm Res 34:64–82PubMed Frank G, Pasquini E (2006) Endoscopic endonasal cavernous sinus surgery, with special reference to pituitary adenomas. Front Horm Res 34:64–82PubMed
19.
Zurück zum Zitat Hashimoto N, Kikuchi H (1990) Transsphenoidal approach to infrasellar tumors involving the cavernous sinus. J Neurosurg 73:513–517PubMed Hashimoto N, Kikuchi H (1990) Transsphenoidal approach to infrasellar tumors involving the cavernous sinus. J Neurosurg 73:513–517PubMed
20.
Zurück zum Zitat Jho HD, Carrau RL (1997) Endoscopic endonasal transsphenoidal surgery: experience with 50 patients. J Neurosurg 87(1):44–51PubMed Jho HD, Carrau RL (1997) Endoscopic endonasal transsphenoidal surgery: experience with 50 patients. J Neurosurg 87(1):44–51PubMed
21.
Zurück zum Zitat Kitano M, Taneda M (2001) Extended transsphenoidal approach with submucosal posterior ethmoidectomy for parasellar tumors. Technical note. J Neurosurg 94:999–1004 Kitano M, Taneda M (2001) Extended transsphenoidal approach with submucosal posterior ethmoidectomy for parasellar tumors. Technical note. J Neurosurg 94:999–1004
22.
Zurück zum Zitat Sabit I, Schaefer SD, Couldwell WT (2000) Extradural extranasal combined transmaxillary transsphenoidal approach to the cavernous sinus: a minimally invasive microsurgical model. Laryngoscope 110:286–291PubMedCrossRef Sabit I, Schaefer SD, Couldwell WT (2000) Extradural extranasal combined transmaxillary transsphenoidal approach to the cavernous sinus: a minimally invasive microsurgical model. Laryngoscope 110:286–291PubMedCrossRef
23.
Zurück zum Zitat Landolt AM, Lomax N (2000) Gamma knife radiosurgery for prolactinomas. J Neurosurg 93(Suppl 3):14–18PubMed Landolt AM, Lomax N (2000) Gamma knife radiosurgery for prolactinomas. J Neurosurg 93(Suppl 3):14–18PubMed
24.
Zurück zum Zitat Pan L, Zhang N, Wang EM et al (2000) Gamma Knife radiosurgery as a primary surgical treatment for prolactinomas. J Neurosurg 93(suppl 3):10–13PubMed Pan L, Zhang N, Wang EM et al (2000) Gamma Knife radiosurgery as a primary surgical treatment for prolactinomas. J Neurosurg 93(suppl 3):10–13PubMed
25.
Zurück zum Zitat Pouratian N, Sheehan J, Jagannathan J et al Gamma knife radiosurgery for medically and surgically refractory prolactinomas. Neurosurgery 59:255–266 Pouratian N, Sheehan J, Jagannathan J et al Gamma knife radiosurgery for medically and surgically refractory prolactinomas. Neurosurgery 59:255–266
26.
Zurück zum Zitat Petrovich Z, Yu C, Giannotta SL et al Gamma knife radiosurgery for pituitary adenoma: Early results. Neurosurgery 53:51–59 Petrovich Z, Yu C, Giannotta SL et al Gamma knife radiosurgery for pituitary adenoma: Early results. Neurosurgery 53:51–59
27.
Zurück zum Zitat Pollock BE, Nippoldt TB, Stafford SL et al (2002) Results of stereotactic radiosurgery in patients with hormone-producing pituitary adenomas: factors associated with endocrine normalization. J Neurosurg 97:525–530PubMed Pollock BE, Nippoldt TB, Stafford SL et al (2002) Results of stereotactic radiosurgery in patients with hormone-producing pituitary adenomas: factors associated with endocrine normalization. J Neurosurg 97:525–530PubMed
28.
Zurück zum Zitat Shin M, Kurita H, Sasaki T et al (2000) Stereotactic radiosurgery for pituitary adenoma invading the cavernous sinus. J Neurosurg 93(suppl 3):2–5PubMed Shin M, Kurita H, Sasaki T et al (2000) Stereotactic radiosurgery for pituitary adenoma invading the cavernous sinus. J Neurosurg 93(suppl 3):2–5PubMed
29.
Zurück zum Zitat Laws ER Jr, Vance ML (1999) Radiosurgery for pituitary tumors and craniopharyngiomas. Neurosurg Clin North Am 10:327–336 Laws ER Jr, Vance ML (1999) Radiosurgery for pituitary tumors and craniopharyngiomas. Neurosurg Clin North Am 10:327–336
30.
Zurück zum Zitat Morange-Ramos I, Regis J, Dufour H et al (1998) Gamma-knife surgery for secreting pituitary adenomas. Acta Neurochir (Wien) 140(5):437–443CrossRef Morange-Ramos I, Regis J, Dufour H et al (1998) Gamma-knife surgery for secreting pituitary adenomas. Acta Neurochir (Wien) 140(5):437–443CrossRef
31.
Zurück zum Zitat Johnston DG, Hall K, Kendall-Taylor P et al (1984) Effect of dopamine agonist withdrawal after long-term therapy in prolactinomas: studies with highdefinition computerised tomography. Lancet 2:187–192PubMedCrossRef Johnston DG, Hall K, Kendall-Taylor P et al (1984) Effect of dopamine agonist withdrawal after long-term therapy in prolactinomas: studies with highdefinition computerised tomography. Lancet 2:187–192PubMedCrossRef
32.
Zurück zum Zitat Wang C, Lam KSL, Ma JT et al (1987) Long-term treatment of hyperprolactinaemia with bromocriptine: effect of drug withdrawal. Clin Endocrinol (Oxf) 27:363–371 Wang C, Lam KSL, Ma JT et al (1987) Long-term treatment of hyperprolactinaemia with bromocriptine: effect of drug withdrawal. Clin Endocrinol (Oxf) 27:363–371
33.
Zurück zum Zitat Zarate A, Canales ES, Cano C et al Follow-up of patients with prolactinomas after discontinuation of long-term therapy with bromocriptine. Acta Endocrinol (Copenh) 104:139–142 Zarate A, Canales ES, Cano C et al Follow-up of patients with prolactinomas after discontinuation of long-term therapy with bromocriptine. Acta Endocrinol (Copenh) 104:139–142
34.
Zurück zum Zitat Passos VQ, Souza JJS, Musolino NRC et al (2002) Long-term follow-up of prolactinomas: normoprolactinemia after bromocriptine withdrawal. J Clin Endocrinol Metab 87:3578–3582PubMedCrossRef Passos VQ, Souza JJS, Musolino NRC et al (2002) Long-term follow-up of prolactinomas: normoprolactinemia after bromocriptine withdrawal. J Clin Endocrinol Metab 87:3578–3582PubMedCrossRef
35.
Zurück zum Zitat Colao A, Di-Sarno A, Cappabianca P et al (2003) Withdrawal of long-term cabergoline therapy for tumoral and nontumoral hyperprolactinemia. N Engl J Med 349(21):2023–2033PubMedCrossRef Colao A, Di-Sarno A, Cappabianca P et al (2003) Withdrawal of long-term cabergoline therapy for tumoral and nontumoral hyperprolactinemia. N Engl J Med 349(21):2023–2033PubMedCrossRef
36.
Zurück zum Zitat Liuzzi A, Dallabonzana D, Oppizzi G, Verde GG, Cozzi R, Chiodini P, Luccarelli G (1985) Low doses of dopamine agonists in the long-term treatment of macroprolactinomas. N Engl J Med 313(11):656–659PubMedCrossRef Liuzzi A, Dallabonzana D, Oppizzi G, Verde GG, Cozzi R, Chiodini P, Luccarelli G (1985) Low doses of dopamine agonists in the long-term treatment of macroprolactinomas. N Engl J Med 313(11):656–659PubMedCrossRef
37.
Zurück zum Zitat Moriondo P, Travaglini P, Nissim M et al (1985) Bromocriptine treatment of microprolactinomas: evidence of stable prolactin decrease after drug withdrawal. J Clin Endocrinol Metab 60:764–772PubMedCrossRef Moriondo P, Travaglini P, Nissim M et al (1985) Bromocriptine treatment of microprolactinomas: evidence of stable prolactin decrease after drug withdrawal. J Clin Endocrinol Metab 60:764–772PubMedCrossRef
38.
Zurück zum Zitat van ‘t Verlaat JW, Croughs RJ (1991) Withdrawal of bromocriptine after long-term therapy for macroprolactinomas: effect on plasma prolactin and tumour size. Clin Endocrinol (Oxf) 34:175–178 van ‘t Verlaat JW, Croughs RJ (1991) Withdrawal of bromocriptine after long-term therapy for macroprolactinomas: effect on plasma prolactin and tumour size. Clin Endocrinol (Oxf) 34:175–178
39.
Zurück zum Zitat Jones SE, James RA, Hall K et al (2000) Optic chiasmal herniation–an under recognized complication of dopamine agonist therapy for macroprolactinoma. Clin Endocrinol (Oxf) 53(4):529–534CrossRef Jones SE, James RA, Hall K et al (2000) Optic chiasmal herniation–an under recognized complication of dopamine agonist therapy for macroprolactinoma. Clin Endocrinol (Oxf) 53(4):529–534CrossRef
Metadaten
Titel
Five years follow-up of invasive prolactinomas with special reference to the control of cavernous sinus invasion
verfasst von
Zhe Bao Wu
Zhi Peng Su
Jin Sen Wu
Wei Ming Zheng
Qi Chuan Zhuge
Ming Zhong
Publikationsdatum
01.03.2008
Verlag
Springer US
Erschienen in
Pituitary / Ausgabe 1/2008
Print ISSN: 1386-341X
Elektronische ISSN: 1573-7403
DOI
https://doi.org/10.1007/s11102-007-0072-4

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