Comparison of long term results between prolactin secreting adenomas and ACTH secreting adenomas. 1990

K D Post, and J E Habas
Department of Neurological Surgery, College of Physicians and Surgeons, Columbia University, New York, New York 10032.

A series of 100 prolactin secreting pituitary adenomas was reviewed and demonstrated an early cure rate of 85.2% with a cure rate of 89% if prolactin was less than 200 ng/ml. For macroadenomas the cure rate was 50% giving an overall cure rate of 71% for the entire group. When long term (greater than 5 years) followup was obtained a 17% incidence of recurrence was noted for the microadenoma group with a 20% recurrence rate for the macroadenoma group. Secretory dynamic studies were done shortly after surgery and then after a delay. Many showed a return to normal prolactin secretory dynamic suggesting that the underlying hypothalamic regulation is normal in most patients. Abnormal secretory dynamics at 6 weeks post operative testing were not predictive of which patients would relapse as many patients who had abnormal dynamics early did not relapse even during prolonged followup. Conversely a normal response to provocative testing did not preclude late relapse. A similar series of 40 consecutive patients with Cushing's disease was reviewed. Tumor was found in all but three cases. 84% of patients were cured and thus far only one patient (2.5%) has shown late recurrence with this occurring at 6 2/3 years following surgery with normal stimulatory dynamics present for five years. The implication is that hypothalamic regulation is normal in Cushing's disease as well. The differences in recurrence rates may be reflective of the aggressiveness with which one disease is treated, with the acceptance of a higher incidence of hypopituitarism as a consequence of more radical surgery for Cushing's disease.

UI MeSH Term Description Entries
D010911 Pituitary Neoplasms Neoplasms which arise from or metastasize to the PITUITARY GLAND. The majority of pituitary neoplasms are adenomas, which are divided into non-secreting and secreting forms. Hormone producing forms are further classified by the type of hormone they secrete. Pituitary adenomas may also be characterized by their staining properties (see ADENOMA, BASOPHIL; ADENOMA, ACIDOPHIL; and ADENOMA, CHROMOPHOBE). Pituitary tumors may compress adjacent structures, including the HYPOTHALAMUS, several CRANIAL NERVES, and the OPTIC CHIASM. Chiasmal compression may result in bitemporal HEMIANOPSIA. Pituitary Cancer,Cancer of Pituitary,Cancer of the Pituitary,Pituitary Adenoma,Pituitary Carcinoma,Pituitary Tumors,Adenoma, Pituitary,Adenomas, Pituitary,Cancer, Pituitary,Cancers, Pituitary,Carcinoma, Pituitary,Carcinomas, Pituitary,Neoplasm, Pituitary,Neoplasms, Pituitary,Pituitary Adenomas,Pituitary Cancers,Pituitary Carcinomas,Pituitary Neoplasm,Pituitary Tumor,Tumor, Pituitary,Tumors, Pituitary
D003480 Cushing Syndrome A condition caused by prolonged exposure to excess levels of cortisol (HYDROCORTISONE) or other GLUCOCORTICOIDS from endogenous or exogenous sources. It is characterized by upper body OBESITY; OSTEOPOROSIS; HYPERTENSION; DIABETES MELLITUS; HIRSUTISM; AMENORRHEA; and excess body fluid. Endogenous Cushing syndrome or spontaneous hypercortisolism is divided into two groups, those due to an excess of ADRENOCORTICOTROPIN and those that are ACTH-independent. Cushing's Syndrome,Hypercortisolism,Syndrome, Cushing,Syndrome, Cushing's
D005500 Follow-Up Studies Studies in which individuals or populations are followed to assess the outcome of exposures, procedures, or effects of a characteristic, e.g., occurrence of disease. Followup Studies,Follow Up Studies,Follow-Up Study,Followup Study,Studies, Follow-Up,Studies, Followup,Study, Follow-Up,Study, Followup
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000236 Adenoma A benign epithelial tumor with a glandular organization. Adenoma, Basal Cell,Adenoma, Follicular,Adenoma, Microcystic,Adenoma, Monomorphic,Adenoma, Papillary,Adenoma, Trabecular,Adenomas,Adenomas, Basal Cell,Adenomas, Follicular,Adenomas, Microcystic,Adenomas, Monomorphic,Adenomas, Papillary,Adenomas, Trabecular,Basal Cell Adenoma,Basal Cell Adenomas,Follicular Adenoma,Follicular Adenomas,Microcystic Adenoma,Microcystic Adenomas,Monomorphic Adenoma,Monomorphic Adenomas,Papillary Adenoma,Papillary Adenomas,Trabecular Adenoma,Trabecular Adenomas
D000324 Adrenocorticotropic Hormone An anterior pituitary hormone that stimulates the ADRENAL CORTEX and its production of CORTICOSTEROIDS. ACTH is a 39-amino acid polypeptide of which the N-terminal 24-amino acid segment is identical in all species and contains the adrenocorticotrophic activity. Upon further tissue-specific processing, ACTH can yield ALPHA-MSH and corticotrophin-like intermediate lobe peptide (CLIP). ACTH,Adrenocorticotropin,Corticotropin,1-39 ACTH,ACTH (1-39),Adrenocorticotrophic Hormone,Corticotrophin,Corticotrophin (1-39),Corticotropin (1-39),Hormone, Adrenocorticotrophic,Hormone, Adrenocorticotropic
D015175 Prolactinoma A pituitary adenoma which secretes PROLACTIN, leading to HYPERPROLACTINEMIA. Clinical manifestations include AMENORRHEA; GALACTORRHEA; IMPOTENCE; HEADACHE; visual disturbances; and CEREBROSPINAL FLUID RHINORRHEA. Adenoma, Prolactin-Secreting, Pituitary,PRL-Secreting Pituitary Adenoma,Pituitary Adenoma, Prolactin-Secreting,Lactotroph Adenoma,Macroprolactinoma,Microprolactinoma,Prolactin-Producing Pituitary Adenoma,Prolactin-Secreting Pituitary Adenoma,Prolactinoma, Familial,Adenoma, Lactotroph,Adenomas, Lactotroph,Lactotroph Adenomas,Macroprolactinomas,Microprolactinomas,PRL Secreting Pituitary Adenoma,PRL-Secreting Pituitary Adenomas,Pituitary Adenoma, PRL-Secreting,Pituitary Adenoma, Prolactin Secreting,Pituitary Adenoma, Prolactin-Producing,Pituitary Adenomas, PRL-Secreting,Pituitary Adenomas, Prolactin-Producing,Pituitary Adenomas, Prolactin-Secreting,Prolactin Producing Pituitary Adenoma,Prolactin Secreting Pituitary Adenoma,Prolactin-Producing Pituitary Adenomas,Prolactin-Secreting Pituitary Adenomas,Prolactinomas

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