Prolaktinomalı olguların klinik değerlendirilmesi

Abstract

Amaç: Kliniğimizdeki agresif seyirli prolaktinoma olgularının tedavi sonuçları ve tedavi yöntemleri retrospektif olarak değerlendirildi. Buna benzer olgularda en uygun takip ve tedavi stratejilerinin belirlenebilmesi amaçlandı. Hastalar ve Yöntem: Bu çalışmamızda, 2004-2013 yılları arasında endokrinoloji kliniği’mizde arşive kayıtlı hipofiz konseyinde multidisipliner yaklaşımla izlenen vakaların verileri retrospektif olarak incelendi. Hastalar medikal tedavi ile remisyon, cerrahi ile remisyon, cerrahi sonrası medikal tedavi ile remisyon, ilaç dirençleri, cerrahi ve medikal tedavi sonrası tümörde progresyon sonrası ikinci cerrahi olarak sınıflandırıldı. Bulgular: Araştırmaya toplam 65 hasta alındı. Hastaların %61.5 (n=40) kadın, %38.4 (n=25) erkek idi. ..Olgular grup 1; makroadenom ( olguların %60’ı), grup 2; mikroadenom (olguların %40’ı) olarak ikiye ayrıldı. Olgulardan 37 kişiye medikal, 7 kişiye cerrahi, 17 kişiye cerrahi sonrası medikal tedavi uygulanmış. Mikroadenom nedeniyle takip edilen olgulardan %69.4’ü medikal tedavi ile, %8.3’ü cerrahi tedavi ile, %8.3’ü cerrahi sonrası medikal tedavi ile remisyon sağlanmış olduğu görüldü. Makroadenom nedeniyle takip edilen 25 olgudan %20 medikal tedavi ile, %16 cerrahi tedavi ile, %48 cerrahi sonrası medikal tedavi ile remisyon sağlandığı saptandı. Olgularda ortalama direnç %11.4 olarak saptandı. Sonuç: Prolaktinoma benign karakterine rağmen tedavisi güç bir hipofiz tümörüdür. Medikal tedavi yanıtlarımız literatür ile benzer olmasına rağmen cerrahi operasyon sıklığımız literatürden daha fazla saptandı. Bu durum çalışmaya ağresif seyirli olguların alınması ile açıklanmaktadır.

Aim: In the present study, the treatment results and treatment methods of the patients who had aggressive-progressing prolactinoma in our clinic were evaluated retrospectively. The purpose was to identify the most appropriate follow-up and treatment strategies in similar cases. Patients and Methods: In this study of ours, the data recorded in our endocrinology clinic between 2004 and 2013 out of the patients, who were followed-up in our clinic with a multidisciplinary approach in Hypophysis Council, were examined retrospectively. The patients were classified as Remission with Medical Treatment, Remission with Surgery, Remission with Medical Treatment After Surgery, Drug Resistance, and Surgery and “Second Surgery after Tumor Progression after Medical Treatment. Results: A total of 65 patients were included in the study. A total of 61.5% (n=40) of the patients were female; and 38.4% (n=25) were male. All of the cases were divided into two as 60% with microadenomas and 40% with macroadenomas. 37 cases received medical treatment, 7 patients received surgery, and 17 patients received medical treatment after surgery. A total of 69.4% of the patients, who were followed up due to microadenoma, had remission with medical treatment; 8.3% had remission with surgical treatment; and 8.3% had remission with medical treatment after surgery. It was determined that 20% of the 25 patients, who were followed-up due to macroadenoma, had remission with medical treatment; 16% had remission with surgical treatment; and 48% had remission with medical treatment after surgery. The average resistance in the cases was 11.4%. Conclusion: Despite its benign nature, prolactinoma is a hypophysis tumor with difficult treatment. Although the medical treatment responses in our study were compatible with existing literature, the prevalence of the surgical operation in our study was found to be more when compared to existing literature. This situation may be explained with the fact that the patients with aggressive progression were included in the present study of ours.