Operasyon Öyküsü Olan ve Olmayan Dev Prolaktinomalı Hastalarda Medikal Tedavi Sonuçlarının Değerlendirilmesi

Öz

Bu tek merkezli retrospektif çalışmada, primer tedavi veya cerrahi sonrası sekonder tedavi olarak medikal tedavinin sonuçlarını değerlendirmeyi ve iki yaklaşım arasındaki takip sonuçlarını karşılaştırmayı amaçladık. Hastalar tek başına medikal tedavi (Grup M) ve cerrahi + medikal tedavi (Grup S+M) olarak gruplandırıldı. Hastaların yaş ve cinsiyet gibi demografik özellikleri ve tanı anındaki yaşları kaydedildi. Tedavi öncesi ve sonrası tümör boyutu, prolaktin (PRL) düzeyleri, Knosp dereceleri, tedaviye tümör yanıtı, hipofonksiyonlarda iyileşme, görme alanı ve biyokimyasal kontrol arasındaki farklar kaydedildi ve iki grup arasında karşılaştırıldı.Çalışmaya dev prolaktinoma tanısı konulan toplam 41 hasta dahil edildi. Hastaların %82.93'ünde hipopituitarizm, %80.59'unda hipogonadizm, %51.22'sinde GH eksikliği, %36.59'unda ACTH eksikliği ve %41.46'sında TSH eksikliği saptandı. Görme alanı defekti %60.53 oranında saptanmıştır. Tanı anındaki tümör hacmi Grup M'de anlamlı olarak daha yüksekti (p<0.001). Tümör hacmindeki ortalama azalma sadece medikal tedavi ile %75.22 ve cerrahi+medikal tedavi ile %60.20 idi (p=0.36). Son vizitte PRL düzeyleri açısından gruplar arasında istatistiksel olarak anlamlı bir fark bulunmadı (p>0.05). Bu çalışmanın sonuçları, dev prolaktinomalı hastalarda tümör hacminin küçülmesi ve PRL değerlerinin normalleşmesi açısından tek başına medikal tedavi ile cerrahi+medikal tedavi arasında anlamlı bir fark olmadığını göstermektedir. Cerrahi, ciddi bası durumları için saklanmalı ve potansiyel olarak gereksiz cerrahi yaklaşımlardan kaçınılmalıdır.

Anahtar Kelimeler

• dev prolaktinoma
• medikal tedavi
• dekompresyon
• tümör hacmi
• prolaktin

Evaluation of Medical Treatment Results in Patients with Giant Prolactinoma Who Previously Underwent Surgery or Not

Öz

In this single-center retrospective study, we aimed to evaluate the results of medical therapy as primary or secondary treatment following surgery and compare follow-up outcomes between the two approaches. Patients were grouped as medical therapy alone (Group M) and surgery plus medical therapy (Group S+M). Patients' demographics, such as age and gender, and age at the diagnosis were recorded. Differences between the pre-and post-treatment tumor size, prolactin (PRL) levels, Knosp grades, tumor response to treatment, improvement in hypofunctions, visual field, and biochemical control were recorded and compared between the two groups. A total of 41 patients diagnosed with giant prolactinomas were included in the study. Hypopituitarism was found in 82.93%, hypogonadism in 80.59%, GH deficiency in 51.22%, ACTH deficiency in 36.59%, and TSH deficiency in 41.46% of the patients. Visual field defects were found by 60.53%. Tumor volume at diagnosis was significantly higher in Group M (p<0.001). A mean tumor volume reduction of 75.22% was observed with medical therapy alone, compared to 60.20% achieved with surgical intervention and medical therapy (p=0.36). The comparison of PRL levels at the last visit revealed no statistically significant difference between the groups (p > 0.05). This study's results demonstrate no statistically significant difference between medical therapy alone and surgery plus medical therapy regarding the reduction of tumor volume and normalization of PRL values in patients with giant prolactinomas. Surgery should be reserved for severe compression conditions, and potentially unnecessary surgical approaches should be avoided.

Anahtar Kelimeler

• giant prolactinoma
• medical treatment
• decompression
• tumor volume
• prolactin

Kaynakça

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