LONG TERM OUTCOME OF PITUITARY SURGERY FOR PROLACTINOMA

1985年以前切除垂体瘤的患者健康状况的测定。这将表明患者手术后10到30年的情况如何。垂体腺瘤的两种最常见原因是泌乳素瘤和临床无功能肿瘤，每种肿瘤约占所有肿瘤的30-40%。催乳素瘤是一种年轻女性的疾病，是最常见的垂体肿瘤，分泌过多的激素。在确定接受垂体手术切除肿瘤的患者后，将评估其中期病史，包括产科史、进一步治疗史和症状复发。复发的解剖和生理证据将通过体格检查来确定。用胰岛素、甲氧氯丙胺和促甲状腺激素释放激素（TRH）进行激素刺激试验，以确定垂体激素的储备。为了确定垂体的解剖结构，将进行成像程序（计算机断层扫描或磁共振成像）以及视野检查。将进行骨密度测试，以判断患骨质疏松症的风险。患者将在临床研究中心停留几天。生活质量将通过诺丁汉健康概况（NHP）、霍普金斯症状检查表（HSCL）和心理一般健康指数进行评估。溴隐亭自1978年开始在美国使用，降低了大多数患者的血清PRL。80-90%的患者能耐受治疗，血清PRL降低，症状减轻或消失，肿瘤缩小。但停药导致症状复发，血清PRL水平向治疗前水平升高(5)。人们担心，治疗多年（也许50-60年）可能会产生不良后果。

The determination of the well-being of patients who have had the removal of a pituitary tumor prior to 1985. This will indicate how well patients have fared ten to thirty years after the surgery. The two most common causes of pituitary adenomas are prolactinoma and clinically non-functioning tumors, where each comprises about 30-40% of all tumors. Prolactinoma, a disorder of young women, is the most common of the pituitary tumors with excess secretion of a hormone. After the identification of patients who underwent pituitary surgery for removal of tumors, the interim history, including obstetrical history, history of further treatment, and recurrence of symptoms, will be evaluated. Anatomic and physiologic evidence of recurrence will be determined by physical examination. Hormone stimulation tests with insulin, metoclopromide, and thyrotropin releasing hormone (TRH) will be given to determone the reserve of pituitary hormones. To determine the anatomy of the pitutary gland, an imaging procedure (computerized tomography or magnetic resonance imaging) will be given as well as a visual field examination. A bone mineral density test will be done to tell the risk of osteoporosis. Patients will remain in the Clinical Research Center for several days. Quality of life will be evaluated by using the Nottingham Health Profile (NHP), the Hopkins Symptom Checklist (HSCL), and the Psychological General Well-Being Index. Bromocriptine has been used in the United States since 1978, lowering the serum PRL in the majority of patients. 80-90% of the patients can tolerate treatment and have reduction in serum PRL, diminution or disappearance of symptoms, and shrinkage of the tumor. But withdrwawl of the medication leads to return of symptoms and increase of the serum PRL level toward the pre-therapy level (5). There is concern that treatment for many years (perhaps 50-60), could have adverse consequences.