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Comparison of Long Term Results Between Prolactin Secreting Adenomas and ACTH Secreting Adenomas

Published online by Cambridge University Press:  18 September 2015

Kalmon D. Post  and
Jo-Ellen Habas
Kalmon D. Post*
Affiliation:
Department of Neurological Surgery, College of Physicians and Surgeons, Columbia University, New York
Jo-Ellen Habas
Affiliation:
Department of Medicine, College of Physicians and Surgeons, Columbia University, New York
*
Professor and Vice Chairman, Department of Neurological Surgery, College of Physicians and Surgeons, Columbia University, New York, New York 10032 USA
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Abstract:

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A series of 100 prolactin secreting pituitary adenomas was reviewed and demonstrated an early cure rate of 85.2% with a cure rate of 89% if prolactin was less than 200 ng/ml. For macroadenomas the cure rate was 50% giving an overall cure rate of 71% for the entire group. When long term (> 5 years) followup was obtained a 17% incidence of recurrence was noted for the microadenoma group with a 20% recurrence rate for the macroadenoma group. Secretory dynamic studies were done shortly after surgery and then after a delay. Many showed a return to normal prolactin secretory dynamics suggesting that the underlying hypothalamic regulation is normal in most patients. Abnormal secretory dynamics at 6 weeks post operative testing were not predictive of which patients would relapse as many patients who had abnormal dynamics early did not relapse even during prolonged followup. Conversely a normal response to provocative testing did not preclude late relapse. A similar series of 40 consecutive patients with Cushing's disease was reviewed. Tumor was found in all but three cases. 84% of patients were cured and thus far only one patient (2.5%) has shown late recurrence with this occurring at 62/3 years following surgery with normal stimulatory dynamics present for five years. The implication is that hypothalamic regulation is normal in Cushing's disease as well. The differences in recurrence rates may be reflective of the aggressiveness with which one disease is treated, with the acceptance of a higher incidence of hypopituitarism as a consequence of more radical surgery for Cushing's disease.

Type
Special Supplement - Secreting Pituitary Adenomas
Information
Canadian Journal of Neurological Sciences , Volume 17 , Issue 1 , February 1990 , pp. 74 - 77
Copyright
Copyright © Canadian Neurological Sciences Federation 1990

References

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