目的:大泌乳素瘤患者视野损害的治疗是一项重大的治疗挑战。我们旨在研究与大泌乳素瘤相关的视觉发病率及其在药物和手术治疗后的结果。我们旨在确定视觉恢复的预测因素。
方法:我们回顾性回顾了患者的数据,包括临床表现,串联垂体磁共振成像,实验室测试,视觉症状和神经眼科检查,视野测试和光学相干断层扫描测试。主要结果是视野完全恢复。进行了描述性分析。研究了视觉恢复的预测因子。
方法:该研究队列包括150名患有大泌乳素瘤的患者[中位随访,6.0年(四分位数间距(IQR)2.9-10.6)]。
结果:在诊断时,40例(26.7%)患者视野缺损明显.在后续行动结束时,39个可用视野测试中的24个(61.5%)表现出完全恢复。视力完全恢复的患者在诊断时的大腺瘤较小[30.5mm(15.0-80.0)与42.0毫米(30.0-85.0),p<.01],较低的基线血清催乳素水平[1414mcg/L(489-3586)与4119mcg/L(2715-6315),p<.01],中枢性腺机能减退率较低(78.3%vs.93.3%,p=0.05)和中枢甲状腺功能减退症(20.8%vs.53.3%,p=.04),压缩性视神经病变的发生率较低(35.3%vs.87.5%,p=.02)和更好的视敏度(双眼均优于6/8,93.7%与28.6%,p<.01)。
结论:在我们的150例大型泌乳素瘤患者队列中,40例患者(26.7%)存在视野缺损,其中61.5%在治疗后视力完全恢复。视力完全恢复的患者表现为较小的大腺瘤,降低血清催乳素水平,中枢性腺功能减退症和中枢甲状腺功能减退症的发生率较低,较低的压缩性视神经病变和更好的视力。
OBJECTIVE: The management of visual field damage in patients with macroprolactinomas is a major therapeutic challenge. We aimed to study the visual morbidity associated with macroprolactinoma and its outcomes following medical and surgical treatment. We aimed to identify predictors of visual recovery.
METHODS: We retrospectively reviewed patient\'s data including clinical presentation, serial pituitary magnetic resonance imaging, laboratory tests, visual symptoms and neuro-ophthalmologic examination, visual field tests and optical coherence tomography tests. The main outcome was complete visual field recovery. Descriptive analyses were conducted. Predictors of visual recovery were investigated.
METHODS: The study cohort included 150 patients with macroprolactinoma [median follow-up, 6.0 years (interquartile range (IQR) 2.9-10.6)].
RESULTS: At diagnosis, visual field defects were evident in 40 patients (26.7%). At the end of follow-up, 24 out of 39 available visual field tests (61.5%) exhibited complete recovery. Patients that achieved complete visual recovery had smaller macroadenomas at diagnosis [30.5 mm (15.0-80.0) vs. 42.0 mm (30.0-85.0), p < .01], lower baseline serum prolactin levels [1414 mcg/L (489-3586) vs. 4119 mcg/L (2715-6315), p < .01], lower rates of central hypogonadism (78.3% vs. 93.3%, p = .05) and central hypothyroidism (20.8% vs. 53.3%, p = .04), lower rates of compressive optic neuropathy (35.3% vs. 87.5%, p = .02) and a better visual acuity (better than 6/8 in both eyes, 93.7% vs. 28.6%, p < .01).
CONCLUSIONS: In our cohort of 150 patients with macroprolactinoma, 40 patients (26.7%) presented with visual field defects, of which 61.5% achieved complete visual recovery with treatment. Patients that achieved complete visual recovery presented with smaller macroadenomas, lower serum prolactin levels, lower rates of central hypogonadism and central hypothyroidism, lower rates of compressive optic neuropathy and better visual acuity.