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Titolo:
An ultrarapid prognostic index in microprolactinoma surgery
Autore:
Guieu, R; Dufour, H; Grisoli, F; Jaquet, P; Guieu, Y; Rosso, JP; Munier, M; Dicostanzo, V; Brue, T; Enjalbert, A; Begoud, D; Rochat, H;
Indirizzi:
Fac Med Nord, Biochim Lab, CNRS, UMR 6065, F-13015 Marseille, France Fac Med Nord Marseille France F-13015 MR 6065, F-13015 Marseille, France CHU Timone Adultes, Serv Neurochirurg, Marseille, France CHU Timone Adultes Marseille France erv Neurochirurg, Marseille, France CHU Timone Adultes, Serv Endocrinol, Marseille, France CHU Timone AdultesMarseille France Serv Endocrinol, Marseille, France CHU Timone Adultes, Dept Anesthesie Reanimat, Marseille, France CHU TimoneAdultes Marseille France sthesie Reanimat, Marseille, France Coll H Matisse, Nice, France Coll H Matisse Nice FranceColl H Matisse, Nice, France Hop Nord, Biochim Lab, Marseille, France Hop Nord Marseille FranceHop Nord, Biochim Lab, Marseille, France
Titolo Testata:
JOURNAL OF NEUROSURGERY
fascicolo: 6, volume: 90, anno: 1999,
pagine: 1037 - 1041
SICI:
0022-3085(199906)90:6<1037:AUPIIM>2.0.ZU;2-#
Fonte:
ISI
Lingua:
ENG
Soggetto:
PITUITARY-ADENOMAS; PROLACTINOMAS; BROMOCRIPTINE; ADENOMECTOMY;
Keywords:
prolactinoma; neurosurgery; prognostic index;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
14
Recensione:
Indirizzi per estratti:
Indirizzo: Guieu, R Facseille,rd, Biochim Lab, CNRS, UMR 6065, Blvd Pierre Dramard, F-13015 Mar Fac Med Nord Blvd Pierre Dramard Marseille France F-13015 15 Mar
Citazione:
R. Guieu et al., "An ultrarapid prognostic index in microprolactinoma surgery", J NEUROSURG, 90(6), 1999, pp. 1037-1041

Abstract

Object. Prolactinomas account for approximately 40% of pituitary tumors. If the tumor does not exceed 10 mm at its largest diameter (microprolactinoma), the chances of definitive cure as a result of surgery alone vary from 62 to 89% depending on the series. Until now, however, there was no mechanism to predict whether total excision of a tumor had been accomplished. To improve the chances of total excision, we compared the peri- and postoperative kinetics of circulating prolactin (PRL) in patients judged to be cured and those not cured. Methods. The pre-, peri-, and postoperative variations in blood PRL concentrations were determined using assays conducted at 10-minute intervals. Of the 36 patients included in the study, 27 were considered cured (resumptionof a normal menstrual cycle within 6 months, PRL concentration at 9 days [mean +/- standard deviation 2.5 +/- 2.1 ng/ml] and 12 months [4.5 +/- 2.2 ng/ml] after the operation < 10 ng/ml and normally stimulated by metoclopramide and thyrotropin-releasing hormone [TRH]). Nine patients were not cured (PRL 20 +/- 15.7 ng/ml at 9 days after surgery, with no response to metoclopramide and TRH). The kinetics of PRL decrease in definitively cured patients were characterized by the following: 1) the initial slope of the curve decreased by at least 11% within the first 10 minutes after resection, and 2) immediate postoperative PRL concentrations were 20 ng/ml or less. Conclusions. The measurement of the kinetics of PRL decrease during surgery allows the chance of gross-total resection to be successfully predicted less than 25 minutes after excision of the adenoma. Provided an ultrarapid assay is available (the test used in the present study took < 15 minutes), this prognostic index would be useful to make a decision to continue the surgical procedure when the initial PRL slope is judged to be insufficient. Its use may also be extended to other pituitary tumors such as somatotropic adenoma and basophilic adenoma (Cushing's disease).

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 05/12/20 alle ore 10:39:10