| ObjectiveTo assess the relationships between preoperative PRL,GH levels,tumor size,gender,age and tumor invasiveness of Growth hormone-secreting adenoma and Prolactinomas and the early effects of transsphenoidal microsurgical operation,to discuss the predictors of long-term remission of patients and provide evidences on further therapeutic strategies for postoperative patients with Growth hormone-secreting adenoma and Prolactinomas.Materials and MethodsWe collected and analyzed 33 initial treated cases of patients with prolactin (PRL) adenomas and 22 initial treated cases of patients with growth hormone (GH) adenoma of our department with complete data.All patients were tested preoperative PRL,GH levels and that within the first 3 days,30 days following surgery,analyzed age composition,gender differences and the tumor size of MRI.The invasiveness of pituitary adenomas were judged according to Hardy's classification scheme modified by Wilson.All patients were received transsphenoidal microsurgical treatment performed by one operator and followed up for 1-12 months.Clinical evaluation criteria:①Cure:normalization of hormonal levels,disappearence of clinic symptoms, and no recurrence in follow-up period.②Remission:clinic symptoms were sharply improved,and hormonal levels normalized or reduced more than 50%.③Persistence:hormonal levels reduced less than 50%,and clinic symptoms were not improved.Result1.There were 33 patients with PRL-secreting pituitary adenomas,8 males and 25 females,12 patients with invasive adenomas and 21 patients with noninvasive adenomas.There was statistically significant difference between the preoperative serum PRL and the postoperative serum PRL within the first 3 days,30 days following surgery (P＜0.01).The postoperative serum PRL within the first 3 days and the 30 days following surgery was not statistically significant(P＞0.05).The size of invasive adenomas and the size of non-invasive adenomas was statistically significant (P＜0.01).Logistic regression analysis indicated that the incidence of invasive adenomas in patients with a larger tumor is 1.435 times higher than that of patients with a smaller tumor.The occurrence rate of invasive adenomas in women is 12.5% of men.The age,the preoperative serum PRL levels,the remission rate between the patients with invasive adenomas and the patients with non-invasive adenomas had no statistically significant difference (P＞0.05).The occurrence rate of invasive adenomas of patients with PRL values≥200μg/L was no significantly higher than that of patients with PRL values≤100μg/L and 100-200μg/L (P＞0.05).The postoperative remission rate of patients with PRL values＜200μg/L was no significantly lower than that of≥200μg/L(P＞0.05).2.There were 22 patients with GH-secreting pituitary adenomas,8 males and 14 females,11 patients with invasive adenomas and 11 patients with noninvasive adenomas.There was statistically significant difference between the preoperative serum GH and the postoperative serum GH within the first 3 days,30 days following surgery (P＜0.01).The postoperative serum GH within the first 3 days and the 30 days following surgery was not statistically significant(P＞0.05).The size of invasive adenomas and that of non-invasive adenomas was statistically significant (P＜0.01). Logistic regression analysis indicated that the incidence of invasive adenomas in patients with a larger tumor is 17.981 times higher than that of patients with a smaller tumor;the invasiveness of tumor had no relationship with sex.The age,the preoperative serum GH levels,the remission rate between the patients with invasive adenomas and that of the patients with non-invasive adenomas had no statistically significant difference (P＞0.05).The occurrence rate of invasive adenomas of patients with GH values≥50μg/L was no significantly higher than that of patients with GH values≤30μg/L and 30-50μg/L (P＞0.05).The postoperative remission rate of patients with GH values≤50μg/L was no significantly lower than that of＞50μg/L(P＞0.05).3.There were 34 patients who had postoperative complications.The main complications are temporary insipidus,hyponatremia,hypopituitarism.There was no significant difference on the incidence of surgical complications between patients with invasive adenomas and patients with noninvasive adenomas (P＞0.05).Conclusion1.The early postoperative PRL,GH levels may serve as the indicators of recent operative effect.2.The invasion of tumor was closely related to the size and not to the preoperative PRL,GH levels,age.The invasiveness of tumor in womem is less than that in men.3.The incidence of complications,the recent effect of operation were not significantly different with the invasiveness of tumor. |
