ergoline and Diabetes-Insipidus--Neurogenic

To describe a patient who was misdiagnosed as having a nonfunctional pituitary tumor due to the hook effect on prolactin measurements.. A 45-year-old female was admitted with visual disturbances, panhypopituitarism and central diabetes insipidus due to pituitary tumor recurrence. She had been operated 4 times earlier and received cranial irradiation for a suspected nonfunctional pituitary adenoma. Serum prolactin was moderately elevated (164.5 ng/ml), but increased markedly after 1:100 dilution to 14,640 ng/ml. Diagnosis of a giant macroprolactinoma was made and cabergoline was started. Prolactin level normalized and a mild shrinkage of the tumor was achieved after 12 months of therapy.. The hook effect must be kept in mind while evaluating a giant pituitary adenoma with moderately elevated prolactin levels. This way unnecessary surgical procedures or irradiation may be avoided.

Topics: Antineoplastic Agents; Cabergoline; Diabetes Insipidus, Neurogenic; Diagnostic Errors; Ergolines; Female; Glucocorticoids; Humans; Hypopituitarism; Middle Aged; Neoplasm Recurrence, Local; Pituitary Neoplasms; Prednisolone; Prolactin; Prolactinoma; Thyroxine

To evaluate our experience regarding the treatment of pituitary macroadenomas with cavernous sinus invasion in a series of 23 cases of transphenoidal resection.. Twenty two patients, fifteen males and seven females, with ages ranging from 27 to 75 (mean of 48), were operated under protocol by a single surgeon between May of 2002 and December of 2004. Preoperatively all lesions were diagnosed by MRI and staged according to the Knosp classification. All tumors had extension to one or both cavernous sinuses. Four patients were considered to be grade 1, two grade 2, one grade 3 and sixteen grade 4. Twenty three operations were performed on twenty-two patients. Twenty cases were the standard transsphenoidal approach, and three were endoscopic. Postoperatively, the excision was classified as Complete or Total, Subtotal or Partial. Mean follow up was 15 months. The variables considered for analysis include invasion and resection grades. All six patients with graded 1 and 2 lesions and two patients with grade 4 lesions underwent a complete resection. Subtotal (greater than 80%) excision was achieved in one patient with a grade 3 tumor and six patients with grade 4 tumors. The remaining seven patients with grade 4 adenomas had a Partial (less than 80%) excision. We compare de resection grade versus invasion grade with exact Fisher test. And there is not estadistical difference (p=0.12).. The Knosp classification alone cannot predict the behavior of these tumors. In our experience, despite tumor extension to the cavernous sinus, pituitary macroadenomas can be safely resected with low morbidity and mortality.

Topics: Adenoma; Adult; Aged; Antineoplastic Agents; Cabergoline; Cavernous Sinus; Combined Modality Therapy; Cranial Irradiation; Diabetes Insipidus, Neurogenic; Dose Fractionation, Radiation; Endoscopy; Ergolines; Female; Follow-Up Studies; Humans; Hypophysectomy; Magnetic Resonance Imaging; Male; Meningitis; Middle Aged; Neoplasm Invasiveness; Neoplasm Staging; Pituitary Neoplasms; Postoperative Complications; Predictive Value of Tests; Prognosis; Prospective Studies; Radiography; Radiotherapy, Adjuvant; Somatostatin; Sphenoid Bone; Treatment Outcome