PDF(Pubmed)
Abstract：
Pituitary adenomas (PAs) are the third most common brain tumors in adults right after meningiomas and gliomas. Taking into account their hormonal activity in vivo, they can be divided in functioning PAs, which secrete hormones, and nonfunctioning pituitary adenomas (NFPAs), which are not associated with increased hormone secretion. We present the case of a man diagnosed with pituitary apoplexy. A transsphenoidal surgery was performed with subtotal removal of the mass. Pituitary hormones were measured before and after the procedure on several occasions, showing always normal PRL values, so he was diagnosed with a clinically NFPA. Two years later, the patient noticed a visual deficit. A new magnetic resonance imaging study was performed, showing adenomatous recurrence, and the patient underwent a new surgery. After this, hormonal evaluation revealed high levels of PRL on several occasions. After treatment with cabergoline was started, PRL levels normalized, the visual deficit improved, and there was a slight adenoma reduction. This case report represents an exception to the paradigm that in the presence of a macroadenoma and normal PRL levels (avoiding the \"hook effect\"), a prolactinoma can be discarded. Moreover, it stresses the importance of comprehensive, regular, and lifelong surveillance of patients with NFPAs and the close monitoring of serum PRL.
摘要：
垂体腺瘤（PAs）是成年人中仅次于脑膜瘤和神经胶质瘤的第三大常见脑肿瘤。考虑到它们在体内的荷尔蒙活性，它们可以在功能PA上进行划分，分泌荷尔蒙，和无功能的垂体腺瘤（NFPA），与激素分泌增加无关。我们介绍了一名被诊断为垂体中风的男子的病例。进行了经蝶窦手术，并切除了肿块。在手术前后多次测量垂体激素，始终显示正常的PRL值，所以他被诊断出患有临床NFPA。两年后,病人注意到视力缺陷。进行了一项新的磁共振成像研究，显示腺瘤性复发，病人接受了新的手术.在这之后,荷尔蒙评估显示PRL水平很高。卡麦角林治疗后开始，PRL水平归一化，视力缺陷有所改善，腺瘤轻微减少。此病例报告代表了在存在大型腺瘤和正常PRL水平（避免“钩子效应”）的范例的例外，催乳素瘤可以丢弃。此外，它强调了全面，常规,对NFPA患者进行终身监测，并密切监测血清PRL。
