Sellar And Parasellar Tumors

antidepressants, reserpine and cimetidine may cause increased levels, as may the systemic disorders, hypothyroidism and chronic renal failure.

Histology

Although lactotroph adenomas are recognized as having two variants that are analogous to the two types of somatotroph adenomas (densely and sparsely granulated), sparsely granulated tumors make up the vast majority.

Biochemical Investigations The diagnosis is made by single blood level measurement and the serum level correlates well with tumor size.

Radiological Investigations As with all pituitary adenomas, good-quality MRI supplemented with plain films is usually sufficient.

Medical Treatment

First-line treatment of prolactinomas is medical. Dopamine agonists such as bromocriptine and cabergoline will reduce prolactin levels to normal in 85% and 92% respectively and will lead to concomitant shrinkage even in giant tumors, causing visual symptoms. Surgery should be reserved for the dopamine-agonist-intolerant or -resistant patient. Radiotherapy has a disappointing track record in the control of hyper-prolactinemia. In patients wishing to conceive, bromocriptine should be continued until a positive pregnancy test, and then stopped. There is no evidence to suggest that bromocriptine is teratogenic. The risk of tumor enlargement in symptomatic patients during pregnancy is 2-5% for treated microadenoma and up to 37% for macroadenoma. Experience would suggest that tumors of less than 5 mm are unlikely to cause problems during pregnancy.

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