AIM: Prolactinoma is a pituitary adenoma that secretes prolactin. Approximately 40% of all pituitary adenomas are prolactinomas. According to size, they are divided into micro, macro and giant prolactinomas. In women, prolactinomas cause irregularities of the menstrual cycle such as amenorrhea, galactorrhea, weight gain, in both sexes they cause sterility, hypogonadism, decreased libido and depression. In macroadenomas, symptoms due to the compression of the surrounding structures are also manifested, such as headache, vomiting, lower chiasmatic syndrome and ophthalmoplegia. Loss of the visual field due to compression of the optic chiasm is caused by a tumor larger than 10-15 mm with suprasellar spreading, which breaks through the diaphragma sellae. Giant prolactinomas are larger than 40 mm and make up 1-5% of all prolactinomas. CASE REPORT: In this article I present the case of a 38-year-old woman from Ukraine with advanced chiasmatic syndrome caused by a giant prolactinoma. The tumor is infiltrating the left cavernous sinus, causing left-sided amaurosis and right-sided temporal hemianopsia. CONCLUSION: Inferior chiasmatic syndrome is characterized by bitemporal hemianopsia, a deterioration of visual acuity, bilateral bow-tie descendent atrophy of the optic nerve disc, and hemianopic rigidity of the pupils. Macroprolactinomas occur more frequently in men than in women. The diagnosis is often delayed, probably because the symptoms of hyperprolactinemia are less obvious in men, while women tend to present earlier due to menstrual cycle irregularities. Prolactinomas usually have a good prognosis. Effective medical treatment with dopamine agonists is available. Knowledge of the prolactinoma symptoms could help the diagnosis of compressive lesions of the optic chiasm.

• Klíčová slova
• Pituitary gland, bitemporal hemianopsia, hyperprolactinemia, prolactinoma,
• MeSH
• agonisté dopaminu MeSH
• dospělí MeSH
• hyperprolaktinemie * diagnóza   etiologie   terapie   MeSH
• lidé MeSH
• nádory hypofýzy * komplikace   diagnóza   terapie   MeSH
• prolaktin MeSH
• prolaktinom * komplikace   diagnóza   patologie   MeSH
• těhotenství MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• Názvy látek
• agonisté dopaminu MeSH
• prolaktin MeSH

Pituitary incidentaloma are being accidentally found during imaging procedures in approximately 10% of normal population. Facing pituitary incidentalomas endocrinologists have to decide about further management based on the assessment of hormonal activity, aetiology, size, and possible compressive symptoms. Treatment of choice for prolactinomas is medical therapy. Surgical treatment is a treatment of choice for other hormonally active tumours and in case of complications as defects of visual field, pituitary apoplexy with compressive symptoms, ophthalmoplegia respectively. Tumour not indicated for surgical treatment are followed-up by imaging techniques and in indicated cases also by endocrinological or visual field evaluation.

• Klíčová slova
• diagnosis, follow‑up, incidentaloma, monitoring, pituitary, therapy, tumor, tumours, type 2 diabetes,
• MeSH
• adenom * diagnóza   MeSH
• apoplexie hypofýzy * diagnóza   etiologie   terapie   MeSH
• endokrinologie * MeSH
• lidé MeSH
• nádory hypofýzy * komplikace   diagnóza   MeSH
• prolaktinom * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Hormone-secreting adenomas are treated in many neurosurgical centers within Europe. The goal of the survey is to understand variance in practice management of pituitary tumors amongst neurosurgical centers. A list of departments performing pituitary surgery was created. The survey consisted of 58 questions. This study focuses on neurosurgical care of hormone-secreting adenomas. For analysis, the departments were divided into four subgroups: academic/non-academic, high-volume/low-volume, "mainly endoscopic/mainly microscopic practice" and geographical regions. Data from 254 departments from 34 countries were obtained. Most centers surgically treat 1-5 hormone-secreting adenomas per year. In prolactinomas this is the case in 194 centers, (76.4%), in GH-secreting adenomas: 133 centers, (52.4%), ACTH-secreting adenomas: 172 centers, (69.8%). Surgery as a primary treatment of prolactinomas is considered in 64 centers (25.2%). In 47 centers (18.8%), GH-secreting microadenomas are often treated pharmacologically first. Debulking surgery for an invasive GH-secreting adenoma in which hormonal remission is not a realistic goal of the surgery and the patient has no visual deficit surgery is always or mostly indicated in 156 centers (62.9%). Routine postoperative hydrocortisone replacement therapy is administered in 147 centers (58.6%). Our survey shows that in most centers, few hormone-secreting adenomas are treated per year. In about 25% of the centers, prolactinoma surgery may be regarded as first-line treatment; in about 20% of the centers, medical treatment is the first-line treatment for GH-secreting adenomas. Pretreatment for ACTH-secreting adenomas is routinely used in 21% of centers. This survey may serve as plea for neurosurgical care centralization of hormone-secreting adenomas.

• MeSH
• adenom * patologie   chirurgie   MeSH
• adrenokortikotropní hormon MeSH
• lidé MeSH
• nádory hypofýzy * patologie   chirurgie   MeSH
• prolaktinom * patologie   chirurgie   MeSH
• retrospektivní studie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• adrenokortikotropní hormon MeSH

PURPOSE: Stereotactic radiosurgery is one of the treatment options for prolactinomas, the most commonly used being Gamma Knife Radiosurgery (GKRS). GKRS is indicated mainly in the treatment of dopamine agonist (DA)-resistant prolactinomas. In our study, we report on our experience in treating prolactinoma patients by GKRS. METHODS: Twenty-eight patients were followed-up after GKRS for 26-195 months (median 140 months). Prior to GKRS, patients were treated with DAs and 9 of them (32.1%) underwent previous neurosurgery. Cavernous sinus invasion was present in 16 (57.1%) patients. Indications for GKRS were (i) resistance to DA treatment (17 patients), (ii) drug intolerance (5 patients), or (iii) attempts to reduce the dosage and/or shorten the length of DA treatment (6 patients). RESULTS: After GKRS, normoprolactinaemia was achieved in 82.1% of patients, out of which hormonal remission (normoprolactinaemia after discontinuation of DAs) was achieved in 13 (46.4%), and hormonal control (normoprolactinaemia while taking DAs) in 10 (35.7%) patients. GKRS arrested adenoma growth or decreased adenoma size in all cases. Two patients (8.3%) developed hypopituitarism after GKRS. Prolactinoma cystic transformation with expansive behaviour, manifested by bilateral hemianopsia, was observed in one patient. CONCLUSIONS: GKRS represents an effective treatment option, particularly for DA-resistant prolactinomas. Normoprolactinaemia was achieved in the majority of patients, either after discontinuation of, or while continuing to take, DAs. Tumour growth was arrested in all cases. The risk of the development of hypopituitarism can be limited if the safe dose to the pituitary and infundibulum is maintained.

• Klíčová slova
• Gamma knife radiosurgery, Hypopituitarism, Prolactinoma, Resistance,
• MeSH
• agonisté dopaminu terapeutické užití   MeSH
• dospělí MeSH
• hemianopsie radioterapie   MeSH
• hypopituitarismus radioterapie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• prolaktinom farmakoterapie   radioterapie   MeSH
• radiochirurgie metody   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• agonisté dopaminu MeSH

PURPOSE: Although several reports have addressed cerebrospinal fluid (CSF) rhinorrhea following dopamine agonist (DA) therapy of macroprolactinomas, further study is warranted for this relatively uncommon entity. Toward this aim, our retrospective series and review of literature further clarifies recommendations in treatment of this rare problem. METHODS: We retrospectively reviewed all macroprolactinoma cases in our hospital for a 15-year period. Our systematic search of PubMed identified original articles and reviews of all macroprolactinoma cases with an associated medication-induced CSF leak. RESULTS: Five patients with drug-induced CSF leak were identified; four of these patients received cabergoline therapy an average of 6 weeks before the onset of rhinorrhea and then underwent surgical repair of the CSF leak. Of 35 published studies included, we identified 60 patients with medication-induced CSF leak. Medical therapy included bromocriptine in 34 patients, cabergoline in 21 patients, and use of both DAs in two patients. Three cases did include complete diagnostic and treatment data. Median time from initiation of the DA treatment to occurrence of rhinorrhea was 6 weeks. For CSF rhinorrhea, 49 patients underwent surgical repair (38 by the transnasal approach) and seven patients were treated nonoperatively. CONCLUSION: Baseline skull base erosion in macroprolactinomas in combination with subsequent tumor shrinkage induced by DA therapy may result in spontaneous CSF rhinorrhea. Therefore, such patients should be advised about and monitored for this potential setback. Once CSF leak is diagnosed, prompt treatment must be carried out to avoid infectious complications. Transnasal surgery appears the most effective therapeutic approach.

• Klíčová slova
• Cerebrospinal fluid leak, Dopamine agonists, Prolactinoma, Rhinorrhea,
• MeSH
• agonisté dopaminu škodlivé účinky   terapeutické užití   MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• prolaktin metabolismus   MeSH
• prolaktinom farmakoterapie   MeSH
• retrospektivní studie MeSH
• rinorea mozkomíšního moku chemicky indukované   MeSH
• senioři MeSH
• únik mozkomíšního moku chemicky indukované   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• Názvy látek
• agonisté dopaminu MeSH
• prolaktin MeSH

AIM: Physiology and pathology of prolactin production, clinical consequences. DESIGN: Review. SETTING: Reprogenesis International, Brno. METHODS: Study of current literature. CONCLUSION: In article is discussed physiology and pathology of prolactin production, influence of hyperprolac-tinaemia to ovarian function - anovulation, irregularities of cycle, amenorrhea. Separately is discussed problem of microprolactinoma and prolactinoma. Review of current therapeutic possibilities.

• Klíčová slova
• hyperprolactinaemia, microprolactinoma, microprolactinoma prolactinoma., prolactin, prolactinoma,
• MeSH
• fertilita MeSH
• lidé MeSH
• nádory hypofýzy * MeSH
• prolaktin metabolismus   MeSH
• prolaktinom * MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• Názvy látek
• prolaktin MeSH

Multiple Endocrine Neoplasia (MEN) is a condition in which several endocrine organs of an individual are affected by adenoma, hyperplasia and less often carcinoma, either simultaneously or at different stages of life. Two existing syndromes, MEN1 and MEN2 (2A, 2B), in literature is also mentioned MEN4, are associated also with other non-endocrine disorders. MEN1 (Wermer syndrome) affects the pituitary, parathyroid, and pancreatic area. 95 % of patients show very early manifestation of hyperparathyroidism, often before 40 years of age. Multiple adenomas gradually involve all four parathyroid glands. The first clinical sign of MEN1 includes recurrent nephrolithiasis. The second most frequent manifestation of MEN1 is pancreatic area (pancreas, stomach and duodenum), again multiple malignancies of varying degree which can metastasize. Most often gastrinomas and insulinomas are involved. Pituitary adenomas occur in about one third of MEN1 patients and tend to be larger and less responsive to treatment. Tumors appearing most often are prolactinomas, tumors producing growth hormone, or afunctional adenomas. The other endocrine tumors include carcinoids and adrenal lesions. In the last year we have registered four MEN1 syndrome patients in our center and one patient has been already followed since 2008. In four out of five patients, nephrolithiasis after 30 years of age was the first clinical symptom, but only one of theses cases resulted in MEN1 diagnosis. In all patients, the clinical symptoms intensified and the diagnosis was established between 36 and 40 years of age. A crutial factor is a cooperation with the urology examination of kidney stones formation in young individuals with nephrolithiasis in order to reveal the potential cases of MEN1 syndrome very early on. Consider the MEN1 genetic diagnostics if recurrent primary hyperparathyroidism or recurrent gastroduodenal ulcer disease appear in patients under 40 years of age.Key words: carcinoid - gastrinoma - hyperparathyroidism - insulinoma - MEN1 - multiple endocrine neoplasia - nefrolithiasis - neuroendocrine tumor - pancreatic area - pituitary gland.

• MeSH
• adenom diagnóza   etiologie   MeSH
• dospělí MeSH
• gastrinom diagnóza   etiologie   MeSH
• hyperparatyreóza diagnóza   etiologie   MeSH
• inzulinom diagnóza   etiologie   MeSH
• lidé MeSH
• mnohočetná endokrinní neoplazie typu 1 komplikace   diagnóza   MeSH
• nádory hypofýzy diagnóza   etiologie   MeSH
• nádory příštítného tělíska diagnóza   etiologie   MeSH
• nádory slinivky břišní diagnóza   etiologie   MeSH
• nefrolitiáza etiologie   MeSH
• peptický vřed etiologie   MeSH
• prolaktinom diagnóza   etiologie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

To treat pituitary adenomas, three modes of treatment are usually combined: neurosurgery, radiation and pharmacological. Prolactinomas are an exception with predominantly pharmacological management. Patients with acromegaly are usually diagnosed late and thus many neurosurgeries fail to completely remove the adenoma. Any residual tumour tissue is usually irradiated with the Leksell Gamma Knife, and dopamine agonists, somatostatine analogues or growth hormone receptor antagonists are used to normalize the hormonal hypersecretion until the complete effect of the radiation. The same surgical and Gamma Knife procedures are used in patients with the Cushing's disease and TSH-secreting adenomas. Ketoconazole, metyrapone and cabergoline are used until the radiation effect in the Cushing's disease is complete, similarly, somatostatine analogues are used in TSH-secreting adenomas. Nonfunctional adenomas are less responsive to pharmacological treatment. Proautophagic cytostatic temozolamide has been used in aggressive pituitary adenomas and carcinomas.

• MeSH
• adenom komplikace   terapie   MeSH
• akromegalie etiologie   MeSH
• hypersekrece ACTH v hypofýze etiologie   MeSH
• lidé MeSH
• nádory hypofýzy komplikace   terapie   MeSH
• prolaktinom terapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• přehledy MeSH

OBJECTIVE: Pharmacological treatment with dopaminergic agonists (DA) is the treatment of choice for prolactinomas. Surgical and radiation treatment is also indicated in certain situations. We describe our 12-year experience in treating prolactinomas with the Leksell gamma knife (LGK). DESIGN: We followed 35 prolactinoma patients (25.7% microprolactinomas, 74.3% macroprolactinomas) treated with LGK irradiation. The mean follow-up period was 75.5 months. Prior to LGK irradiation, patients were treated with DA and 10 of them (28.6%) underwent neurosurgery. Indications for LGK irradiation were: DA intolerance (31.4%), DA resistance (45.7%) and efforts to reduce the DA dose or shorten the period of administration (22.9%). Pituitary function was monitored regularly at 6-month intervals. The central radiation dose range was 40-80 Gy (median 70 Gy), and the minimal peripheral dose was 20-49 Gy (median 34 Gy). RESULTS: Normoprolactinaemia was achieved in 37.1% of the patients who discontinued DA and in 42.9% of patients who continued DA treatment after LGK irradiation. The median time to prolactin normalization after discontinuation of DA was 96 months. No relapse was seen in any patient. After LGK irradiation, the prolactinoma stopped growing or decreased in size in all but one patient (97.1%). CONCLUSION: LGK treatment resulted in normoprolactinaemia in 80.0% of the patients, all of whom had failed pharmacological treatment due to DA resistance or intolerance. After achieving normoprolactinaemia, no relapse of hyperprolactinaemia was observed in any patient. The size of the adenoma decreased even in those patients in whom it was not changed by previous DA treatment.

• MeSH
• agonisté dopaminu terapeutické užití   MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• mladiství MeSH
• mladý dospělý MeSH
• nádory hypofýzy krev   farmakoterapie   patologie   chirurgie   MeSH
• následné studie MeSH
• prolaktin krev   MeSH
• prolaktinom krev   farmakoterapie   patologie   chirurgie   MeSH
• radiochirurgie přístrojové vybavení   MeSH
• senioři MeSH
• těhotenství MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• agonisté dopaminu MeSH
• prolaktin MeSH

OBJECTIVES: Retrospective follow-up study on patients suffering from macroprolactinomas which were treated with agonists of D2 receptors; the MRI results were correlated with the clinical symptomatology and with the level of prolactin in the blood. METHODS: From 1996 to 2006 we followed 38 patients diagnosed with macroprolactinoma. All patients underwent MRI in same protocol two times. The indication for MRI was based on the clinical symptomatology (signs of hormonal dysfunction, visual fields impairment) or increased blood level of prolactin. RESULTS: The first predominant clinical signs in males were local manifestations of expansive process and in women hormonal dysfunction. Intratumorous haemorrhage in patients undergoing the treatment with the agonists of D2 receptors is common, it was encountered in 25 cases, but only in two cases it was followed by a more serious clinical symptomatology, which had to be referred to the department of the neurosurgery. Even when there were pronounced regressions or near complete disappearance of the tumour and normalisation of the blood level of prolactin, withdrawal of the treatment with agonists of D2 receptors caused increase in size of the adenoma and increase of level of prolactinaemia. CONCLUSION: Only two patients presented with serious clinical symptomatology associated with intratumoral hemorrhage. The hemorrhages are more common during the first weeks of therapy, but can happen at any time thought out the treatment with D2 receptor agonists. Our hypothesis: the prolactinomas with higher level of prolactin have greater tendency for larger hemorrhages.

• MeSH
• agonisté dopaminu škodlivé účinky   terapeutické užití   MeSH
• dospělí MeSH
• intrakraniální krvácení etiologie   MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• nádory hypofýzy krev   komplikace   diagnostické zobrazování   farmakoterapie   MeSH
• následné studie MeSH
• prolaktin krev   MeSH
• prolaktinom krev   komplikace   diagnostické zobrazování   farmakoterapie   MeSH
• radiografie MeSH
• receptory dopaminu D2 agonisté   MeSH
• retrospektivní studie MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• agonisté dopaminu MeSH
• prolaktin MeSH
• receptory dopaminu D2 MeSH