Implications of very high serum prolactin levels associated with pituitary tumors

1980 ◽  
Vol 52 (2) ◽  
pp. 226-228 ◽  
Author(s):  
William A. Shucart
Keyword(s):  
Cavernous Sinus ◽  
Tumor Size ◽  
Pituitary Tumors ◽  
High Serum ◽  
Serum Prolactin ◽  
Content Type ◽  
Invasive Tumor ◽  
Very High ◽  
Suprasellar Extension ◽  
Fine Print

✓ Five patients with pituitary tumors associated with unusually high serum prolactin levels are presented. Tumor size and the presence of suprasellar extension were variable, but the finding common to all five cases was invasion of the cavernous sinus. It is proposed that very high serum prolactin levels suggest an invasive tumor, perhaps, specifically, invasion into a cavernous sinus. The surgical significance of this proposition is discussed.

Serum prolactin in patients with hypothalamus and pituitary disorders

1981 ◽  
Vol 55 (2) ◽  
pp. 194-199 ◽  
Author(s):  
Per Olov Lundberg ◽  
Per Olof Osterman ◽  
Leif Wide
Keyword(s):  
Pituitary Adenoma ◽  
Pituitary Adenomas ◽  
Single Case ◽  
Geometric Mean ◽  
High Serum ◽  
Serum Prolactin ◽  
Content Type ◽  
Sellar Tumor ◽  
Very High ◽  
Fine Print

✓ Serum prolactin concentrations were studied in 115 patients with anatomically defined disorders in the hypothalamo-pituitary region. Fifty of the patients had expansively growing pituitary adenomas; in 17 of them (13 females and four males) the prolactin values were slightly raised (15 to 100 µg/liter), and in 13 (11 females and two males) they were over 100 µg/liter. The frequency of elevated prolactin values was higher for females than for males. Fifteen patients with invasively growing pituitary adenomas had very high serum prolactin levels (range 1230 to 31,500 µg/liter, geometric mean 3150 µg/liter). In a single case of malignant pituitary adenoma, the serum prolactin was at the lower level of detection. Of 49 further patients with suprasellar meningiomas, craniopharyngiomas, or other expansive or destructive lesions of the hypothalamus and sellar region, 15 had slightly raised prolactin values (maximum 114 µg/liter). Eight of these 49 patients had sellar destruction, with a roentgenological picture similar to that in patients with invasive pituitary adenomas. Among these eight patients, the maximum prolactin value was 67 µg/liter. It is concluded that moderately raised serum prolactin values (up to 100 µg/liter) in a patient with a sellar tumor does not prove that the tumor is a prolactinoma. A serum prolactin value of 100 to 1000 µg/liter strongly indicates a prolactin-producing tumor. In a patient with sellar destruction, a serum prolactin value of over 1000 µg/liter is proof that the destruction is caused by an invasive pituitary adenoma.

Management of prolactinomas associated with very high serum prolactin levels

1988 ◽  
Vol 68 (4) ◽  
pp. 554-558 ◽  
Author(s):  
Daniel L. Barrow ◽  
Junichi Mizuno ◽  
George T. Tindall
Keyword(s):  
Pituitary Adenomas ◽  
High Serum ◽  
Serum Prolactin ◽  
Treatment Control ◽  
Content Type ◽  
Preoperative Serum ◽  
Group A ◽  
Group B ◽  
Very High ◽  
Fine Print

✓ The authors have reviewed the results of transsphenoidal microsurgical management in 69 patients with prolactin-secreting pituitary adenomas who had preoperative serum prolactin levels over 200 ng/ml. The patients were divided into three groups based on their preoperative serum prolactin levels: over 200 to 500 ng/ml (Group A); over 500 to 1000 ng/ml (Group B); and over 1000 ng/ml (Group C). The percentage of successful treatment (“control rate”) was 68%, 30%, and 14%, respectively, in these three groups of patients. Based on these results, the authors offer guidelines for the management of patients with prolactin-secreting pituitary adenomas associated with exceptionally high serum prolactin levels. The surgical control rate of 68% in Group A seems to justify surgery for these patients, while primary medical care with bromocriptine is recommended for most patients with serum prolactin levels over 500 ng/ml.

The specificity of serum prolactin as a diagnostic indicator of pituitary adenoma

1979 ◽  
Vol 51 (1) ◽  
pp. 42-46 ◽  
Author(s):  
Saul Balagura ◽  
Andrew G. Frantz ◽  
Edgar M. Housepian ◽  
Peter W. Carmel
Keyword(s):  
Pituitary Adenoma ◽  
Neurological Disease ◽  
Pituitary Tumors ◽  
Serum Prolactin ◽  
Content Type ◽  
Regular Work ◽  
Work Up ◽  
Diagnostic Indicator ◽  
Fine Print ◽  
Rule Out

✓ Serum prolactin levels were determined in 205 patients with a variety of intracranial diseases, including 70 cases with pituitary tumors. It is concluded that although the absence of elevated prolactin levels does not help to rule out pituitary pathology, the presence of hyperprolactinemia is highly specific for diseases of the pituitary and hypothalamus, and prolactin determination should be part of the regular work-up of pituitary tumor suspects. Excluding known causes of hyperprolactinemia, such as tranquilizing drug ingestion, the presence of neurological disease outside the hypothalamic-pituitary area was not associated with increased serum prolactin concentrations.

Transsphenoidal extracapsular approach to pituitary tumors

1986 ◽  
Vol 64 (1) ◽  
pp. 16-20 ◽  
Author(s):  
Nobuo Hashimoto ◽  
Hajime Handa ◽  
Tatsuhito Yamagami
Keyword(s):  
Pituitary Adenomas ◽  
Transsphenoidal Surgery ◽  
Pituitary Tumors ◽  
Hormonal Control ◽  
Arachnoid Membrane ◽  
Content Type ◽  
Tumor Capsule ◽  
Suprasellar Extension ◽  
Fine Print ◽  
Transsphenoidal Resection

✓ Two years' experience with an extracapsular transsphenoidal approach to pituitary adenomas is presented. Some pituitary tumors contain an inordinate amount of connective tissue that often makes transsphenoidal resection difficult. By opening the tumor capsule and adjacent arachnoid membrane, such tumors with suprasellar extension can be safely removed. In some cases of functioning adenoma, resection of the diaphragma sellae and adjacent arachnoid membrane results in hormonal control. Among 62 cases of transsphenoidal surgery for pituitary adenomas, eight cases required this procedure. The surgical procedure is described and the cases are summarized. The indication and limitations of this procedure are discussed.

Follow-up study with computerized tomography and clinical evaluation 5 to 10 years after surgery for pituitary adenoma

1980 ◽  
Vol 53 (2) ◽  
pp. 144-148 ◽  
Author(s):  
Carin Muhr ◽  
Kjell Bergstrom ◽  
Paul Enoksson ◽  
Rune Hugosson ◽  
Per Olov Lundberg
Keyword(s):  
Pituitary Adenoma ◽  
Computerized Tomography ◽  
No Value ◽  
Content Type ◽  
Follow Up Study ◽  
Field Defect ◽  
Very High ◽  
Suprasellar Extension ◽  
Fine Print

✓ This study was based on 24 consecutive patients operated on for pituitary adenoma with suprasellar extension, and treated postoperatively with radiotherapy. The follow-up period was 5 to 10 years. A clinical examination, endocrine evaluation, perimetry, computerized tomography (CT) and sellar roentgenography were performed in 19 of 20 surviving patients. The CT scans revealed four recurrences, while perimetry only showed an increased visual field defect in one patient. Plain sellar films were of no value for diagnosis of recurrence. Prolactin determinations seemed to have a limited value in recurrence diagnosis, but very high levels spoke in favor of a recurrence. Thus, CT was found to be the superior method of diagnosing recurrences. It is proposed that CT be used regularly in the follow-up study of patients operated on for a pituitary adenoma.

Clinical and pathological effects of bromocriptine on prolactin-secreting and other pituitary tumors

1984 ◽  
Vol 60 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Daniel L. Barrow ◽  
George T. Tindall ◽  
Kalman Kovacs ◽  
Michael O. Thorner ◽  
Eva Horvath ◽  
...  
Keyword(s):  
Tumor Size ◽  
Pituitary Tumors ◽  
Size Reduction ◽  
Pathological Examination ◽  
Primary Therapy ◽  
Pathological Changes ◽  
Content Type ◽  
Group A ◽  
Group B ◽  
Fine Print

✓ Bromocriptine inhibits prolactin secretion and causes size reduction of prolactin-secreting adenomas. The effect of the drug upon pituitary tumors other than prolactinomas is uncertain. The authors report a prospective series of 12 patients with pituitary macroadenomas in whom bromocriptine was administered for 6 weeks prior to transsphenoidal surgery. Five of the patients had computerized tomographic documentation of significant reductions in tumor size (Group A) and six had no change (Group B) during 3 and 6 weeks of bromocriptine administration. One patient who demonstrated size reduction in his tumor was not assigned to either group as he was treated with high-dose dexamethasone concurrently with the bromocriptine. Pathological examination (light and electron microscopy and immunocytochemistry) indicated that all Group A patients harbored tumors with prolactin granules whereas all Group B tumors lacked such granules. Adenoma cells in the responsive tumors were involuted with reduced cytoplasmic, nuclear, and nucleolar areas. Neither widespread cell necrosis, infarction, nor vascular injury was observed. Two of the five Group A patients discontinued bromocriptine prior to completion of the 6-week protocol and had a rapid return of their tumors to pre-treatment size. Although bromocriptine has been reported to cause shrinkage of nonfunctional tumors, there was no radiological evidence of size reduction or pathological changes in the nonfunctional tumors of this series. Interestingly, serum levels of prolactin were modestly elevated (84 and 113 ng/ml) in two of the six Group B patients, an elevation due to stalk compression rather than secretion by adenoma cells. This finding underscores the fact that failure of bromocriptine to reduce pituitary tumor size in the presence of hyperprolactinema may occur because the tumor is other than a prolactinoma. This is the first moderate-sized group of patients in whom pathological changes in responsive prolactinomas during bromocriptine therapy have been demonstrated. As bromocriptine is not tumoricidal, and thus not curative, there is insufficient evidence to recommend this drug as primary therapy for either prolactin-secreting or nonfunctional macroadenomas, but the drug may have potential as a preoperative adjunct to effect shrinkage of prolactinomas and theoretically, at least, make excision easier and possibly more complete.

Gamma knife radiosurgery in the management of cavernous sinus meningiomas

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 68-73 ◽  
Author(s):  
Pierre-Hugues Roche ◽  
Jean Régis ◽  
Henry Dufour ◽  
Henri-Dominique Fournier ◽  
Christine Delsanti ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Tumor Growth ◽  
Gamma Knife ◽  
Cavernous Sinus ◽  
Gamma Knife Radiosurgery ◽  
Surgical Removal ◽  
Content Type ◽  
Cavernous Sinus Meningioma ◽  
The Mean ◽  
Fine Print

Object. The authors sought to assess the functional tolerance and tumor control rate of cavernous sinus meningiomas treated by gamma knife radiosurgery (GKS). Methods. Between July 1992 and October 1998, 92 patients harboring benign cavernous sinus meningiomas underwent GKS. The present study is concerned with the first 80 consecutive patients (63 women and 17 men). Gamma knife radiosurgery was performed as an alternative to surgical removal in 50 cases and as an adjuvant to microsurgery in 30 cases. The mean patient age was 49 years (range 6–71 years). The mean tumor volume was 5.8 cm3 (range 0.9–18.6 cm3). On magnetic resonance (MR) imaging the tumor was confined in 66 cases and extensive in 14 cases. The mean prescription dose was 28 Gy (range 12–50 Gy), delivered with an average of eight isocenters (range two–18). The median peripheral isodose was 50% (range 30–70%). Patients were evaluated at 6 months, and at 1, 2, 3, 5, and 7 years after GKS. The median follow-up period was 30.5 months (range 12–79 months). Tumor stabilization after GKS was noted in 51 patients, tumor shrinkage in 25 patients, and enlargement in four patients requiring surgical removal in two cases. The 5-year actuarial progression-free survival was 92.8%. No new oculomotor deficit was observed. Among the 54 patients with oculomotor nerve deficits, 15 improved, eight recovered, and one worsened. Among the 13 patients with trigeminal neuralgia, one worsened (contemporary of tumor growing), five remained unchanged, four improved, and three recovered. In a patient with a remnant surrounding the optic nerve and preoperative low vision (3/10) the decision was to treat the lesion and deliberately sacrifice the residual visual acuity. Only one transient unexpected optic neuropathy has been observed. One case of delayed intracavernous carotid artery occlusion occurred 3 months after GKS, without permanent deficit. Another patient presented with partial complex seizures 18 months after GKS. All cases of tumor growth and neurological deficits observed after GKS occurred before the use of GammaPlan. Since the initiation of systematic use of stereotactic MR imaging and computer-assisted modern dose planning, no more side effects or cases of tumor growth have occurred. Conclusions. Gamma knife radiosurgery was found to be an effective low morbidity—related tool for the treatment of cavernous sinus meningioma. In a significant number of patients, oculomotor functional restoration was observed. The treatment appears to be an alternative to surgical removal of confined enclosed cavernous sinus meningioma and should be proposed as an adjuvant to surgery in case of extensive meningiomas.

Stereotactic radiotherapy for the treatment of acoustic neuromas

2004 ◽  
Vol 101 (Supplement3) ◽  
pp. 362-372 ◽  
Author(s):  
Michael T. Selch ◽  
Alessandro Pedroso ◽  
Steve P. Lee ◽  
Timothy D. Solberg ◽  
Nzhde Agazaryan ◽  
...  
Keyword(s):  
Stereotactic Radiotherapy ◽  
Tumor Size ◽  
Cranial Nerve ◽  
Target Volume ◽  
Tumor Control ◽  
Content Type ◽  
Seventh Cranial Nerve ◽  
Acoustic Neuromas ◽  
Fine Print

Object. The authors sought to assess the safety and efficacy of stereotactic radiotherapy when using a linear accelerator equipped with a micromultileaf collimator for the treatment of patients with acoustic neuromas. Methods. Fifty patients harboring acoustic neuromas were treated with stereotactic radiotherapy between September 1997 and June 2003. Two patients were lost to follow-up review. Patient age ranged from 20 to 76 years (median 59 years), and none had neurofibromatosis. Forty-two patients had useful hearing prior to stereotactic radiotherapy. The fifth and seventh cranial nerve functions were normal in 44 and 46 patients, respectively. Tumor volume ranged from 0.3 to 19.25 ml (median 2.51 ml). The largest tumor dimension varied from 0.6 to 4 cm (median 2.2 cm). Treatment planning in all patients included computerized tomography and magnetic resonance image fusion and beam shaping by using a micromultileaf collimator. The planning target volume included the contrast-enhancing tumor mass and a margin of normal tissue varying from 1 to 3 mm (median 2 mm). All tumors were treated with 6-MV photons and received 54 Gy prescribed at the 90% isodose line encompassing the planning target volume. A sustained increase greater than 2 mm in any tumor dimension was defined as local relapse. The follow-up duration varied from 6 to 74 months (median 36 months). The local tumor control rate in the 48 patients available for follow up was 100%. Central tumor hypodensity occurred in 32 patients (67%) at a median of 6 months following stereotactic radiotherapy. In 12 patients (25%), tumor size increased 1 to 2 mm at a median of 6 months following stereotactic radiotherapy. Increased tumor size in six of these patients was transient. In 13 patients (27%), tumor size decreased 1 to 14 mm at a median of 6 months after treatment. Useful hearing was preserved in 39 patients (93%). New facial numbness occurred in one patient (2.2%) with normal fifth cranial nerve function prior to stereotactic radiotherapy. New facial palsy occurred in one patient (2.1%) with normal seventh cranial nerve function prior to treatment. No patient's pretreatment dysfunction of the fifth or seventh cranial nerve worsened after stereotactic radiotherapy. Tinnitus improved in six patients and worsened in two. Conclusions. Stereotactic radiotherapy using field shaping for the treatment of acoustic neuromas achieves high rates of tumor control and preservation of useful hearing. The technique produces low rates of damage to the fifth and seventh cranial nerves. Long-term follow-up studies are necessary to confirm these findings.

External carotid-cavernous sinus fistula diagnosed by common carotid arteriography

1974 ◽  
Vol 41 (4) ◽  
pp. 494-498 ◽  
Author(s):  
Louis Wener ◽  
Giovanni Di Chiro ◽  
Robert A. Mendelsohn
Keyword(s):  
Cavernous Sinus ◽  
Carotid Arteries ◽  
External Carotid ◽  
Carotid Cavernous Fistula ◽  
Content Type ◽  
Cavernous Fistula ◽  
Carotid Cavernous Sinus Fistula ◽  
The Difference ◽  
Fine Print

✓ An external carotid-cavernous fistula diagnosed by serial common carotid arteriography is reported. The diagnosis was reached on the basis of the difference in time between filling of the distal internal and external carotid arteries and the visualization of the fistula.

Thyrotrophin-producing pituitary adenomas

1982 ◽  
Vol 57 (4) ◽  
pp. 515-519 ◽  
Author(s):  
Stephen A. Hill ◽  
James M. Falko ◽  
Charles B. Wilson ◽  
William E. Hunt
Keyword(s):  
Thyroid Hormone ◽  
Pituitary Adenomas ◽  
Preoperative Diagnosis ◽  
Pituitary Tumors ◽  
Recurrent Tumor ◽  
Hormone Production ◽  
Content Type ◽  
Aggressive Tumor ◽  
Tsh Levels ◽  
Fine Print

✓ Hyperthyroidism due to thyrotrophin (TSH)-secreting pituitary tumors is rare. Four cases are described, with the features that allow preoperative diagnosis. In all the patients, thyroid hormone production was consistently elevated despite antithyroid therapy, and TSH levels were inappropriately elevated. All patients were treated with both surgery and irradiation. Each patient had recurrent tumor with suprasellar, intrasphenoidal, or intraorbital spread. The combination of a recurrent, aggressive tumor complicated by thyrotoxicosis makes this a complex and difficult surgical problem.

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