Dijagnostičke i terapijske mogućnosti liječenja prolaktinskih tumora

master's thesis

• Title (english): Diagnostic and therapeutic possibilities of treatment of prolactinomas
• Author: Stjepan Šimić
• Mentor: Milan Vrkljan (mentor)
• Committee member: Neven Ljubičić (predsjednik povjerenstva)
• Committee member: Nikola Đaković (član povjerenstva)
• Committee member: Milan Vrkljan (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2018-07-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Oncology

Abstract

Prolaktinomi su najčešći tumori hipofize koji luče hormone. Čine otprilike 40% svih pituitarnih tumora te se procijenjuje da je prevalencija 500, a incidencija 27 na milijun ljudi u populaciji. Prolaktinomi se na osnovi veličine dijele na mikroprolaktinome, (<10 mm) makroprolaktinome (>10 mm) i divovske prolaktinome (>4 cm). Koncentracije prolaktina u serumu najčešće su proporcionalne veličini tumora (>250 μg/l za makroprolaktinome). Anamneza i status su ključni za dijagnozu prolaktinoma. Nakon toga slijedi mjerenje koncentracije prolaktina u serum. Nakon dokazane hiperprolaktinemije slijede ostali krvni testovi koji isključuju ostale diferencijalno dijagnostičke uzroke hiperprolaktinemije. Ti testovi podrazumjevaju testove hipofizne funkcije tj. mjerenje serumskih koncentracija kortizola ujutro, ACTH, FSH, kao i spolnih hormona, biokemijske testove koji isključuju bubrežnu i jetrenu insuficijenciju te test trudnoće za žene. Nakon toga se provode neurooftalmološki pregled i slikovne metode procjene hipofize i selarnog područja. Od slikovnih metoda danas se najviše koristi MRI, a rijeđe CT. PET i SPECT pomoćne metode. Ciljevi liječenja prolaktinoma neovisno o modalitetu terapije su: normalizacija koncentracije prolaktina u serumu, radiološka kontrola tumora što podrazumjeva spriječavanje njegovog rasta, njegovu regresiju te njegovo kompletno uklanjanje; otklanjanje preoperativnih simptoma i prevencija komplikacija liječenja poput hipopituitarizma ili neuroloških simptoma. Prema preporukama Endokrinološkog društva iz 2011. medikamentna terapija D2 agonistom karbegolinom je terapija izbora kod liječenja većine pacijenata s prolaktinomom dok se drugi modaliteti liječenja poput kirurške resekcije i radioterapije koriste u posebnim slučajevima, u slučaju neuspjeha medikamentne terapije te ukoliko je ona kontraindicirana.

Abstract (english)

Prolactinomas are most common pituitary tumours that secrets hormones. It makes for about 40% of all pituitary tumors and it is estimated that prevalence is 500 and incidence is 27 on million people in population. Based on their size, prolactinomas are divided as microprolactinomas,(<10mm) macroprolactinomas(>10mm) and giant prolactinomas(>4cm). Prolactin serum concentration is usually proportional to the size of the tumour (>250 μg/l for macroprolaktinomas). History and clinical examination are essential for the diagnosis of prolactinoma. This is followed by measuring serum prolactin concentration. Following proven hyperprolactinemia we have to perform other blood tests to rule out other causes that are differential diagnosis of hyperprolactinemia. These tests imply pituitary function tests ie. measurement of serum cortisol concentration in the morning, ACTH, FSH and sex hormones, biochemical tests which exclude the renal and hepatic insufficiency and pregnancy test for women. After that neuroophthalmological examination and image assessment methods pituitary and sellar areas are carried out. MRI is imaging technique that is mostly used today while CT usage is rare these days. PET and SPECT are complementary methods. Objectives of therapy of prolactinomas regardless of modality are: normalization of serum prolactin concentrations, radiographic tumour control wich includes preventing tumour growth, tumour regression and its complete removal; elimination of preoperative symptoms and the prevention of complications such as hypopituitarism or neurological symptoms. According to Endocrine Society's recommendations from 2011. medical therapy with D2 agonist carbegoline is treatment of choice in the most patients with prolactinomas while other modalities of treatment such as surgical resection and radiation therapy are used in special cases, in case of failure of medical therapy and if medical therapy is contraindicated.

• Keywords: prolaktinom; hiperprolaktinemija; D2 agonisti; kirurška resekcija
• Keywords (english): prolactinoma; hyperprolactinemia; D2 agonists; surgical resection
• Language: croatian
• URN:NBN: urn:nbn:hr:105:823603
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2018-12-13 08:55:46