Comparison Of The Effects Of Different Managements On Microprolactinomas

Objective:The purpose of this study is to compare and evaluate the effects on medical treatment and surgical treatment of microprolactinoma, and to analyze some prognosis-related factors. Thus this study could provide an optimal treatment strategy for the patient.Methods:We studied a total of 131patients diagnosed Pituitary Microprolactinomas. All the data were collected from the 2nd hospital of Zhejiang University.68 of them received medical treatment, and 63 surgery. All the patients were followed up by observation on changes in clinical manifestation, hormones profiles and their fecundity. The data were analyzed by SPSS 13.0 software.Results:1.All of the 131 patients were women. Multiple regression analysis showed there was a negative correlation between the PRL level in blood and the age of patients. The PRL level in blood was the only factor contributed to the severity of menstrual disorder.2.Patients with less than 20ng/ml PRL on the 1st day after surgery had much more regular menstruation. Most patients with amenorrhea restored normal menstruation cycle within the 1st month after surgery. Patients with shorter secondary amenorrhea courses restored more quickly. Logistic regression indicated that basal prolactin level was related factors to amenorrhea. If the PRL level of the patient came down more than 20folds than that of the previous level, the patient would have better treatment effect.3.Logistic regression indicated that basal prolactin level was the main factor related to clinical effects of the management. Patients whose PRL level restored within 1 month had better prognosis.4.The efficiency of operation group was 94.1%(64/68), and that of drug treatment group is 90.5%(57/63). No difference in treatment effect was seen among the two by chi square test. Surgery is more effective than bromocriptine if patients are less than 20, or basal prolactin level is lower than 200ng/m, or the course is less than 6 months.5.16(23.5%) patients had post operational complication, including cerebrospinal fluid leak, transient diabetes insipidus, epistaxis and hypopituitarism.32(50.8%) patients in drug treatment group had side effect. The major symptoms were upper gastrointestinal disturbances, postural hypotension, constipation, alopecia, and slight impairment in liver function.Conclusions:1.Pre-treatment plasma PRL level can forecast post-treatment plasma PRL level and the therapeutic effect.2.It is an independent predictive value for forecasting the treatment effect whether the PRL level of the patient comes down more than 20folds than that of the previous level. Whether the PRL level restores within lmonth after drug treatment is another independent predictive value.3.Transsphenoidal surgery and drug (Bromcriptine) applications are both effective treatment methods for pituitary microprolactinomas. It is better to choose transsphenoidal surgery for patients who are less than 20, or whose PRL is less than 200ng/ml, or whose course is less than 6months.