| Abstrakt: |
The clinical and laboratory findings in 115 women with altered menstrual function and abnormal polytomograms were reviewed. All women were treated by transsphenoidal exploration for suspected pituitary adenomas. Adenomas were found in 92 women. Eight patients had cystic lesions which may have represented degenerating tumors. Fifteen women had negative explorations because neither visual nor pathologic evidence of a tumor was found at operation. The incidence of amenorrhea was similar in both the women with documented tumors (87 of 92, 94%) and those with negative explorations (14 of 15, 93%). The incidence of galactorrhea, however, was higher in the women with tumors (85 of 92, 92%) compared to those without tumors (11 of 15, 73%). In addition, all women with tumors had elevated serum prolactin levels (range: 29 to 2,800 ng/ml; median: 130 ng/ml). Of the women with negative explorations, only five of 15 (33%) had elevated prolactin levels (range of elevation: 48 to 143 ng/ml). All patients in this series had abnormal sellar architecture by polytomography prior to operation. All patients in the negative exploration group had central abnormalities of sellar size and shape marked by generalized enlargement without asymmetry. In contrast, x-ray abnormalities in the tumor group were predominantly lateral (87%) with clearly demonstrable asymmetry. In the women with negative explorations, one had primary hypothyroidism, three had hypergonadotropinemia secondary to either premature ovarian failure or surgical oophorectomy, four had partially empty sellae, and two had severe headaches. Based on the findings in this series, the following guidelines for the evaluation of patients with suspected pituitary tumors are suggested: (1) The baseline prolactin level is still the most reliable indicator of a prolactin-secreting pituitary adenoma, although not all patients with hyperprolactinemia have pituitary tumors; (2) hypocycloidal polytomography, at present, is probably the most practical and effective method to assess the sella turcica because central abnormalities of the sella, in contrast to those which show asymmetry, must be scrutinized very carefully prior to surgical exploration; (3) primary thyroid or ovarian failure may be associated with enlargement of the sella without a demonstrable tumor. |
