Detection, evaluation, and treatment of pituitary microadenomas in patients with galactorrhea and amenorrhea

Abstract

Over a period of two and a half years, 34 women with galactorrhea or amenorrhea, all with an abnormal sellar polytomogram, underwent transsphenoidal microsurgical exploration of the sella. Eighteen women and microadenomas (less than or equal to 1 cm. in diameter), seven had macroadenomas (greater than than 1 cm. in diameter), and five had unidentified lesions. Only one women had a normal pituitary gland. Three women had cryosurgery without biopsy. Preoperatively, hyperprolactinemia occurred in 24 of 25 women with adenomas and two of five with nonadenomatous lesions. There were no operative deaths. Significant morbidity occurred in only three patients, none of whom had microadenomas. Postoperatively, menses resumed in 16 of the 17 women with microadenomas and in two of the seven with macroadenomas who presented with amenorrhea. Galactorrhea disappeared in 15 of the 17 women with microadenomas and in four of the seven with macroadenomas who presented with galactorrhea. In five patients with unidentified lesions, a return of menses occurred in two of four with previous amenorrhea, and galactorrhea abated in two of three who presented with lactation. We conclude that sellar polytomography in women with hyperprolactinemia is a useful technique technique for the diagnosis of pituitary adenomas, a lesion which may occur more frequently than previously realized. In addition, transsphenoidal microresection of microadenomas is safe and effective.

PIP: The detection, evaluation, and treatment of pituitary microadenomas in women with galactorrhea and amenorrhea are discussed. All of the women had an abnormal sellar polytomogram and underwent transsphenoidal microsurgical exploration of the sella. 18 women had microadenomas of 1 cm or less in diameter, 7 had macroadenomas greater than 1 cm in diameter, and 5 had unidentified lesions. Only 1 woman had a normal pituitary gland. 3 women had cyrosurgery without biopsy. Preoperatively, hyperprolactinemia occurred in 24 of 25 women with adenomas and 2 of 5 with nonadenomatous lesions. Comparison of serum prolactin values and tumor size by linear-regression analysis revealed a positive correlation (p .05, r=.69). Marked morbidity occurred in 2 patients with macroadenomas and in 1 patient treated by cyrosurgery. Postoperatively, menses resumed in 16 of the 17 women with microadenomas and in 2 of the 7 with macroadenomas who presented with amenorrhea. Galactorrhea disappeared in 15 of the 17 women and in 4 of 7 who presented with galactorrhea. In 5 women with unidentified lesions a return of menses occurred in 2 of 4 with previous amenorrhea, and galactorrhea abated in 2 of 3 who presented with lactation. It is concluded that sellar polytomography in women with hyperprolactinemia is a useful technique for the diagnosis of pituitary adenomas and that transsphenoidal microsection of microadenomas is safe and effective.