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Prolaktinomanın Klinik ve Laboratuar Özellikleri :Tek Merkez Deneyimi

Yıl 2024, Cilt: 4 Sayı: 2, 34 - 39, 22.08.2024
https://doi.org/10.58961/hmj.1494250

Öz

Amaç: Çalışmamızın amacı prolaktinomaların sıklığı, tanı ve tedavisi ile klinik seyrini ortaya koyarak epidemiyolojik çalışmaların hastalıkların klinik yönetimi açısından önemine vurgu yapmaktır.
Gereç ve yöntem: 356 prolaktinoma hastası çalışmaya dahil edildi. Hastaların hastane bilgi yönetim sistemi ve hastaların kayıtlı olduğu endokrin dosyalarından bilgileri tarandı. Taranan bilgiler; hasta yaşı, cinsiyet, tanı yaşı, takip yılı, başvuru şikayeti, adenomun boyutu, yerleşimi, hipofiz adenomunun tanı anında ve tedavi sonrası hormon düzeyleri, varsa kullanılan medikal tedavi çeşidi, hipofiz adenomunun operasyon sayısı ve şekli, medikal yada cerrahi tedavi öncesi ile sonrası adenom boyutu ve varsa rezidü/nüks hipofiz adenom boyutu, kiazma basısı, postop hormon aktivitesi, adenoma yönelik varsa RT öyküsüydü.
Bulgular: 356 prolaktinoma olgularının cinsiyet dağılımına bakıldığında 305’inin (%85.7) kadın, 51’inin (%14.3) erkek olduğu görüldü (p<0.001). Radyolojik olarak 263’ünün (%73.9) mikroadenom, 63’ünün (%17.7) makroadenom ve 30’unun (%8.4) invaziv makroadenom olduğu izlendi. Makroadenomların 6 (%1.6)’sı dev adenom (>4cm) olarak kaydedildi. Mikroadenomlar ise kadınlarda daha sık (%80) görüldü(p<0.001). Makroadenom kadınlarda %20 iken, erkeklerde %58 görülmekteydi(p=0.015). Tanı anındaki adenom boyutu ile prolaktin düzeyi pozitif yönde ilişkili bulundu(r=0.318 p<0.001). Kadınların %14,4’ünde, erkeklerin ise %7.8’inde infertilite görüldü (p=0.035). Kadınların %66.9’unda amenore /oligomenore görülürken; %28.9 ’unda galaktore ve %10.5’ inde hirşutizm tablosu vardı.
Sonuç: Çalışmadan çıkan en önemli sonuçlar: (1) mikroadenomların görülme sıklığı makroadenomlardan daha fazladır,(2) kadınlarda mikroadenom daha sık görülerken, erkeklerde ise makroadenom daha sık saptandı,(3) tanı anındaki adenom boyutu ile prolaktin düzeyi pozitif yönde ilişkili bulundu.

Kaynakça

  • Kovacs K. Tumors of the pituitary gland. Atlas of Tumor Pathology fascicle 21, 2nd series. 1986:1-269.
  • Ezzat S, Asa SL, Couldwell WT, Barr CE, Dodge WE, Vance ML, et al. The prevalence of pituitary adenomas: a systematic review. Cancer: Interdisciplinary International Journal of the American Cancer Society. 2004;101(3):613-9.
  • Chong BW, Kucharczyk W, Singer W, George S. Pituitary gland MR: a comparative study of healthy volunteers and patients with microadenomas. American Journal of Neuroradiology. 1994;15(4):675-9.
  • Erbaş T. Hipofiz Adenomlarının Endokrinolojik Değerlendirilmesi. Hipofiz Adenomları. 2008;1:138-65.
  • Glezer A, Bronstein MD. Prolactinoma. Arquivos Brasileiros de Endocrinologia & Metabologia. 2014;58(2):118-23.
  • Grubu THÇ. Hipofiz Hastaliklari Tani, Tedavi ve izlem Kilavuzu. Ankara, Türkiye Endokrinoloji ve Metabolizma Dernegi. 2019.
  • Yatavelli RKR, Bhusal K. Prolactinoma. StatPearls [Internet]: StatPearls Publishing; 2018.
  • Karavitaki N, Thanabalasingham G, Shore HC, Trifanescu R, Ansorge O, Meston N, et al. Do the limits of serum prolactin in disconnection hyperprolactinaemia need re‐definition? A study of 226 patients with histologically verified non‐functioning pituitary macroadenoma. Clinical endocrinology. 2006;65(4):524-9.
  • Porta‐Etessam J, Ramos‐Carrasco A, Berbel‐García Á, Martínez‐Salio A, Benito‐León J. Clusterlike headache as first manifestation of a prolactinoma. Headache: The Journal of Head and Face Pain. 2001;41(7):723-5.
  • Duskin-Bitan H, Shimon I. Prolactinomas in males: and differences? Pituitary. 2020;23(1):52-7.
  • Daly AF, Rixhon M, Adam C, Dempegioti A, Tichomirowa MA, Beckers A. High prevalence of pituitary adenomas: a cross-sectional study in the province of Liege, Belgium. The Journal of Clinical Endocrinology & Metabolism. 2006;91(12):4769-75.
  • Tjörnstrand A, Gunnarsson K, Evert M, Holmberg E, Ragnarsson O, Rosén T, et al. The incidence rate of pituitary adenomas in western Sweden for the period 2001-2011. European Journal of Endocrinology. 2014;171(4):519-26.
  • Gillam MP, Molitch ME, Lombardi G, Colao A. Advances in the treatment of prolactinomas. Endocrine reviews. 2006;27(5):485-534.
  • Colao A, Di Sarno A, Cappabianca P, Briganti F, Pivonello R, Di Somma C, et al. Gender differences in the prevalence, clinical features and response to cabergoline in hyperprolactinemia. European journal of endocrinology. 2003;148(3):325-31.
  • 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. The Journal of Clinical Endocrinology & Metabolism. 2011;96(2):273-88.
  • Mancini T, Casanueva FF, Giustina A. Hyperprolactinemia and prolactinomas. Endocrinology and metabolism clinics of North America. 2008;37(1):67-99.
  • Ciccarelli A, Daly AF, Beckers A. The epidemiology of prolactinomas. Pituitary. 2005;8(1):3-6.
  • Casanueva FF, Molitch ME, Schlechte JA, Abs R, Bonert V, Bronstein MD, et al. Guidelines of the Pituitary Society for the diagnosis and management of prolactinomas. Clinical endocrinology. 2006;65(2):265-73.

Clinical and Laboratory Features of Prolactinoma: Single Center Experience

Yıl 2024, Cilt: 4 Sayı: 2, 34 - 39, 22.08.2024
https://doi.org/10.58961/hmj.1494250

Öz

Aim: The aim of our study is to emphasize the importance of epidemiological studies in terms of clinical management of diseases by revealing the frequency, diagnosis, treatment and clinical course of prolactinomas.
Materials and Methods: 356 prolactinoma patients were included in the study. The patients' information have taken from the hospital information management system and the endocrine files. Scanned information; patient age, gender, age at diagnosis, follow-up year, complaint at presentation, size and location of the adenoma, hormone levels of the pituitary adenoma at the time of diagnosis and after treatment, type of medical treatment used, if any, number and type of operations of the pituitary adenoma, adenoma before and after medical or surgical treatment, size and residual/recurrent pituitary adenoma size, if any, chiasm compression, postoperative hormone activity, and history of RT for adenoma, if any.
Results: 356 prolactinoma cases was examined, it was seen that 305 (85.7%) were female and 51 (14.3%) were male (p<0.001). It was observed that 263 (73.9%) were microadenomas, 63 (17.7%) were macroadenomas and 30 (8.4%) were invasive macroadenomas. 6 (1.6%) of the macroadenomas were recorded as giant adenomas (>4cm). Microadenomas were seen more frequently in women (80%) (p<0.001). Macroadenoma was seen in 20% of women and 58% of men (p = 0.015). Adenoma size and prolactin level were found to be positively correlated at diagnosis (r=0.318 p<0.001). Infertility was observed in 14.4% of women and 7.8% of men (p = 0.035). Amenorrhea / oligomenorrhea is observed in 66.9% of women; also 28.9% had galactorrhea and 10.5% had hirsutism.
Conclusion: The most important results of the study: (1) the incidence of microadenomas is higher than macroadenomas, (2) microadenomas were more common in women, while macroadenomas were detected more frequently in men, (3) adenoma size and prolactin level were found to be positively correlated at the time of diagnosis.

Kaynakça

  • Kovacs K. Tumors of the pituitary gland. Atlas of Tumor Pathology fascicle 21, 2nd series. 1986:1-269.
  • Ezzat S, Asa SL, Couldwell WT, Barr CE, Dodge WE, Vance ML, et al. The prevalence of pituitary adenomas: a systematic review. Cancer: Interdisciplinary International Journal of the American Cancer Society. 2004;101(3):613-9.
  • Chong BW, Kucharczyk W, Singer W, George S. Pituitary gland MR: a comparative study of healthy volunteers and patients with microadenomas. American Journal of Neuroradiology. 1994;15(4):675-9.
  • Erbaş T. Hipofiz Adenomlarının Endokrinolojik Değerlendirilmesi. Hipofiz Adenomları. 2008;1:138-65.
  • Glezer A, Bronstein MD. Prolactinoma. Arquivos Brasileiros de Endocrinologia & Metabologia. 2014;58(2):118-23.
  • Grubu THÇ. Hipofiz Hastaliklari Tani, Tedavi ve izlem Kilavuzu. Ankara, Türkiye Endokrinoloji ve Metabolizma Dernegi. 2019.
  • Yatavelli RKR, Bhusal K. Prolactinoma. StatPearls [Internet]: StatPearls Publishing; 2018.
  • Karavitaki N, Thanabalasingham G, Shore HC, Trifanescu R, Ansorge O, Meston N, et al. Do the limits of serum prolactin in disconnection hyperprolactinaemia need re‐definition? A study of 226 patients with histologically verified non‐functioning pituitary macroadenoma. Clinical endocrinology. 2006;65(4):524-9.
  • Porta‐Etessam J, Ramos‐Carrasco A, Berbel‐García Á, Martínez‐Salio A, Benito‐León J. Clusterlike headache as first manifestation of a prolactinoma. Headache: The Journal of Head and Face Pain. 2001;41(7):723-5.
  • Duskin-Bitan H, Shimon I. Prolactinomas in males: and differences? Pituitary. 2020;23(1):52-7.
  • Daly AF, Rixhon M, Adam C, Dempegioti A, Tichomirowa MA, Beckers A. High prevalence of pituitary adenomas: a cross-sectional study in the province of Liege, Belgium. The Journal of Clinical Endocrinology & Metabolism. 2006;91(12):4769-75.
  • Tjörnstrand A, Gunnarsson K, Evert M, Holmberg E, Ragnarsson O, Rosén T, et al. The incidence rate of pituitary adenomas in western Sweden for the period 2001-2011. European Journal of Endocrinology. 2014;171(4):519-26.
  • Gillam MP, Molitch ME, Lombardi G, Colao A. Advances in the treatment of prolactinomas. Endocrine reviews. 2006;27(5):485-534.
  • Colao A, Di Sarno A, Cappabianca P, Briganti F, Pivonello R, Di Somma C, et al. Gender differences in the prevalence, clinical features and response to cabergoline in hyperprolactinemia. European journal of endocrinology. 2003;148(3):325-31.
  • 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. The Journal of Clinical Endocrinology & Metabolism. 2011;96(2):273-88.
  • Mancini T, Casanueva FF, Giustina A. Hyperprolactinemia and prolactinomas. Endocrinology and metabolism clinics of North America. 2008;37(1):67-99.
  • Ciccarelli A, Daly AF, Beckers A. The epidemiology of prolactinomas. Pituitary. 2005;8(1):3-6.
  • Casanueva FF, Molitch ME, Schlechte JA, Abs R, Bonert V, Bronstein MD, et al. Guidelines of the Pituitary Society for the diagnosis and management of prolactinomas. Clinical endocrinology. 2006;65(2):265-73.
Toplam 18 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Endokrinoloji
Bölüm Araştırma Makaleleri
Yazarlar

Duygu Kesebi Isganderov 0000-0001-9744-3796

Nur Kebapçı 0000-0002-8286-5256

Yayımlanma Tarihi 22 Ağustos 2024
Gönderilme Tarihi 3 Haziran 2024
Kabul Tarihi 2 Temmuz 2024
Yayımlandığı Sayı Yıl 2024 Cilt: 4 Sayı: 2

Kaynak Göster

Vancouver Kesebi Isganderov D, Kebapçı N. Prolaktinomanın Klinik ve Laboratuar Özellikleri :Tek Merkez Deneyimi. HTD / HMJ. 2024;4(2):34-9.

e-ISSN: 2791-9935