LONG-TERM FOLLOW-UP AFTER TRANSCRANIAL HYPOPHYSECTOMY IN MACROPROLACTINOMAS

CLINICAL CASE

  • Adina Ghemigian The University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania & ”C.I. Parhon” National Institute of Endocrinology, Bucharest, Romania
  • Mara Carsote The University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania & ”C.I. Parhon” National Institute of Endocrinology, Bucharest, Romania
  • Cristina Ghervan ”I.Hatieganu” University of Medicine and Pharmacy & The Clinical County Hospital, Cluj-Napoca, Romania
  • Anda Dumitrașcu ”C.I. Parhon” National Institute of Endocrinology, Bucharest, Romania
  • Simona Elena Albu The University of Medicine and Pharmacy “Carol Davila” Bucharest, Romania & The University Emergency Hospital, Bucharest, Romania
  • Carmen Emanuela Georgescu ”I.Hatieganu” University of Medicine and Pharmacy & The Clinical County Hospital, Cluj-Napoca, Romania
  • Ana Valea ”I.Hatieganu” University of Medicine and Pharmacy & The Clinical County Hospital, Cluj-Napoca, Romania
Keywords: transcranial hypophysectomy, prolactinoma, pituitary tumor, cabergoline, transfrontal pituitary surgery

Abstract

Currently, transcranial hypophysectomy is infrequently used since the trans-sphenoidal approach is
very effective and less invasive. Prolactinomas represent one of the rarest indications for pituitary
surgery due to the spectacular effects of dopamine agonists as cabergoline. A 66-year-old female
presented at age of 52 with headache, low blood pressure. The investigations revealed
panhypopituitarism, high prolactin and a large pituitary mass with obstructive hydrocephalus at the
left lateral ventricle. Transcranial surgery was performed through a right approach without
complications. The pathological report confirmed a pituitary adenoma with intense cellular
pleomorphism. A 29-year-old male was admitted at the age of 28 for severe headache, multiple
episodes of vomiting, and hypotension. Pituitary insufficiency and hyperprolactinemia were
correlated to the presence of an intrasellar tumor of 2/2 cm with extension to the right cavernous
sinus, optic chiasm. The pathological report confirmed a pituitary adenoma. Transcranial pituitary
surgery represents an option only in selected large macroprolactinomas. After procedure, a good
outcome is expected despite the potential secondary eye field defects or pituitary insufficiency
which needs medication. Sometime the panhypopituitarism caused first by the tumor itself persists
after surgery (as in our first case) or it is corrected (as adrenal insufficiency in the second case).
The presence of a residual prolactin producing tumor requires long term specific therapy with
dopamine agonists.

Published
2016-03-10
How to Cite
[1]
A. Ghemigian, “LONG-TERM FOLLOW-UP AFTER TRANSCRANIAL HYPOPHYSECTOMY IN MACROPROLACTINOMAS”, JSS, vol. 3, no. 1, pp. 44-50, Mar. 2016.
Section
Articles