侵袭海绵窦垂体腺瘤的伽玛刀治疗

目的 评价伽玛刀治疗侵袭海绵窦垂体腺瘤的疗效和内分泌激素变化,并分析了治疗后主要的并发症.方法 选择了自1995年9月至2006年1月收治的并获得完全随访资料的128例侵袭海绵窦垂体腺瘤患者,肿瘤直径1.0～4.8 cm(平均3.04 cm),既往手术63例,具有放疗史22例.PRL腺瘤56例,GH腺瘤19例,ACTH腺瘤2例,FSH腺瘤1例,混合性腺瘤22例,无功能性腺瘤28例.采用Leksell立体定位系统,边缘剂量12～35 Gy(平均19.56 Gy).等剂量线45%～50%.平均随访时间34个月.结果 大部分病人均可耐受伽玛刀治疗,急性并发症很少出现.晚期并发症主要表现为视力下降和垂体功能低下.伽玛刀治疗后,肿瘤消失的为4例,肿瘤缩小的为94例,肿瘤大小无变化的26例,4例患者治疗后肿瘤增大,总的肿瘤控制率为96.87%.同时对于功能性腺瘤,于治疗后11例激素水平恢复正常,58例患者激素水平较治疗前下降.结论 伽玛刀治疗侵袭性垂体腺瘤是一种安全、有效的治疗方法.     

溴隐亭治疗侵袭性巨大泌乳素腺瘤的长期随访结果

目的　观察溴隐亭治疗侵袭性巨大泌乳素腺瘤的长期随访结果。方法　纳入侵袭性巨大泌乳素腺瘤 (IGPs)的标准是:⑴肿瘤直径 4cm以上,侵袭海绵窦或邻近其他结构;⑵血浆PRL>200ng/ml;⑶高泌乳素分泌或占位效应引起的临床症状。符合标准者 20例,其中 6例为术后给以溴隐亭治疗,其余 14例首发溴隐亭治疗。11例配合放疗。结果　所有患者临床症状均得到不同程度改善。在平均随访的 37 3个月内肿瘤体积平均缩小 93 3%, 11例肿瘤在MRI上消失。视力下降者除 1例外其余均获得改善(13 /14)。PRL水平控制正常者 8例,大于 200ng/ml者 7例。服药过程中出现脑脊液漏 1例,行经蝶修补。本组在治疗过程中无肿瘤卒中及耐药现象发生。结论　溴隐亭为侵袭性巨大泌乳素腺瘤的首选治疗,能在较短的时间内有效缩小肿瘤体积和控制PRL水平。部分患者服药后肿瘤消失,另一部分患者肿瘤局限后给以立体定向放射外科治疗,从而避免手术风险和手术费用。溴隐亭对控制PRL和缩小肿瘤体积不是同等敏感的。放疗的选择宜慎重。     

大型垂体腺瘤的显微手术治疗

目的 研究大型垂体腺瘤的显微外科治疗结果,探讨其治疗方法和策略.方法 回顾2006年6月至2012年6月收治的垂体腺瘤病例,对56例直径超过3cm的垂体腺瘤的临床及影像学资料、手术入路及显微操作技术、辅助放疗和药物治疗结果进行分析总结.结果 经鼻蝶窦入路40例,经颅入路16例.肿瘤全切27例,次全切25例,部分切除4例.随访获得全切患者仅2例,2年后复发.未能全切除的29例患者中,动态观察无明显生长者9例,余20例行普通放疗者7例,伽玛刀治疗者13例,影像学复查肿瘤渐缩小或不增大.结论 多数大型垂体腺瘤可首选经鼻蝶窦入路显微外科手术治疗.能否全切取决于肿瘤的质地和是否侵袭海绵窦.广泛侵袭海绵窦的巨大、分叶、多方向生长的垂体腺瘤,分期手术或结合放射治疗、药物治疗为较佳选择.     

海绵窦间隙在侵袭海绵窦垂体腺瘤神经内镜经鼻蝶入路切除术中的应用

目的 探讨海绵窦间隙在侵袭海绵窦垂体腺瘤神经内镜经鼻蝶入路切除术中的应用价值。方法 回顾性分析2017年1月至2020年10月经鼻蝶入路神经内镜手术治疗的15例侵袭海绵窦垂体腺瘤的临床资料。基于颈内动脉的自然走形,把海绵窦分为上、下、后、外侧间隙,术中对不同间隙内肿瘤采用不同切除方法。结果 肿瘤全切除11例,次全切除4例。术后发生脑脊液鼻漏1例,尿崩6例,垂体功能减退危象1例,眼球外展障碍1例,动眼神经麻痹1例。15例术后随访3~36个月;11例肿瘤全切除中,10例无复发,1例无功能垂体腺瘤复发并动态观察;4例次全切除中,2例无进展;2例术后6个月内行伽玛刀治疗。结论 神经内镜下经鼻入路手术切除侵袭海绵窦垂体腺瘤的效果良好,基于颈内动脉的自然走形的海绵窦间隙划分方法为侵袭海绵窦垂体腺瘤的手术治疗提供了新思路。     

ADAM10表达和垂体腺瘤海绵窦侵袭性的关系

目的 检测解聚素金属蛋白酶10(ADAM10)在垂体腺瘤组织中的表达,探讨其与垂体腺瘤海绵窦侵袭性的相关性.方法 收集手术切除的垂体腺瘤组织标本,应用免疫组化SP法检测90例腺瘤的ADAM10表达,应用RT-PCR方法检测42例组织的转录水平;分析其与临床资料的相关性.结果 ADAM10阳性率在侵袭性垂体瘤中高于非侵袭组(P＜0.05),ADAM10的表达与年龄、性别、腺瘤内分泌类型及肿瘤直径无相关性(P＞0.05);ADAM10 mRNA水平在侵袭性垂体瘤组中高于非侵袭组(P＜0.05),与腺瘤内分泌类型无关(P＞0.05).结论 ADAM10的表达与腺瘤海绵窦侵袭性密切相关,侵袭性腺瘤中ADAM10表达高.为寻找侵袭性的分子标志物提供了新方向,以调控ADAM10的表达为靶目标,抑制肿瘤细胞的转移和侵袭,有望成为垂体腺瘤治疗的新策略.     

垂体腺瘤PTTG和Ki-67表达与其海绵窦下方间隙生长的关系

目的 研究有海绵窦下方静脉间隙侵袭的垂体瘤组织的免疫组化特性,了解其对于垂体瘤侵袭性预测的意义.方法 对我院2005～2006年行手术治疗的有海绵窦侵袭的垂体瘤患者资料根据有没有海绵窦下方间隙侵袭进行分组,并对不同组别标本行免疫组化Ki-67和PTTG检查.结果 96例患者中有海绵窦下方间隙侵袭者40例,其中Ki-67高表达者32例,PTTG高表达者为30例,无海绵窦段颈内动脉下方侵袭者56例,其中Ki-67高表达者24例,PTTG高表达者为18例,经检验发现肿瘤有海绵窦下方间隙侵袭者其PTTG和Ki-67的表达率与没有海绵窦下方间隙侵袭者的表达率差异有统计学意义.结论 垂体腺瘤有海绵窦下方间隙生长者细胞增殖能力较强,肿瘤易复发,应给予术后放射治疗或是药物治疗.     

经蝶窦显微手术治疗男性泌乳素腺瘤的长期随访分析

目的评价经蝶窦显微外科手术治疗男性泌乳素腺瘤的长期疗效。方法回顾性分析了52例经蝶窦显微手术及病理证实的男性泌乳素腺瘤的临床资料和长期随访结果。结果52例患者平均病程7．2年，性功能障碍31例，视力视野障碍25例，头痛6例。肿瘤大于4cm有17例。手术采用经蝶人路，全切除36例，次全切除11例，大部分及部分切除5例。随访3-17年（平均5．6年），视力视野改善20例，性功能改善10例。术后随访复查CT或MRI提示肿瘤消失37例，残留静止8例，复发7例。结论经蝶人路显微手术是首选手术治疗方法；术后PRL水平、肿瘤的大小以及术中肿瘤切除程度是影响长期疗效的重要因素，但术后PRL水平是预测预后的最好因素。     

神经内镜经鼻入路治疗异形生长侵袭性垂体腺瘤的临床分析

目的探讨异形生长的侵袭性垂体腺瘤神经内镜经鼻手术入路的选择及临床疗效。方法回顾性分析2019年4月至2020年5月首都医科大学附属北京天坛医院神经外科采用神经内镜经鼻入路治疗的117例异形生长的侵袭性垂体腺瘤患者的临床资料。其中肿瘤向鞍上侵袭105例,向侧方侵及海绵窦并包绕颈内动脉80例,向蝶鞍后方侵及脑干19例,向蝶鞍下方侵袭89例。根据垂体腺瘤异形生长的特点分别采用神经内镜经鼻蝶窦-鞍结节-蝶骨平台入路(35例)、神经内镜经筛窦-翼突-蝶窦-海绵窦入路(32例)、神经内镜经鼻蝶窦-斜坡入路(5例)、神经内镜经鼻多通道入路(45例)。术后随访内容包括临床症状、体格检查、头颅MRI及内分泌检验。结果117例患者中,肿瘤全切除67例,次全切除36例,大部分切除14例。无手术相关死亡病例,术后头痛、头晕的缓解率为67.6%(25/37),视力、视野的改善率为66.7%(52/78)。117例患者的中位随访时间为13个月(3~24个月),其中肿瘤复发2例,术后长期垂体功能低下5例,失嗅12例。结论对于异形生长的侵袭性垂体腺瘤,根据肿瘤的生长特点选择不同的神经内镜经鼻入路手术,可减少创伤,提高肿瘤的切除率,临床效果良好。     

侵袭性垂体腺瘤的分子水平研究进展

垂体腺瘤是鞍区常见肿瘤,按照肿瘤生物学行为分三类：非侵袭性垂体腺瘤、侵袭性垂体腺瘤和垂体癌。在实际临床工作中,侵袭性垂体瘤的诊断及治疗相对棘手,肿瘤常常侵犯周围结构如海绵窦、蝶筛窦、上斜坡、鞍底骨质、硬脑膜等,且易发生垂体瘤卒中致病情危急［1］;其诊断主要依靠影像学,通常按Hardy-Wilson分级、分期标准,即蝶鞍正常或局限性扩张,肿瘤＜10 mm为Ⅰ级;蝶鞍扩大,肿瘤≥10 mm为Ⅱ级;鞍底骨质局限性破坏为Ⅲ级;鞍底骨质弥漫性破坏为Ⅳ级;通过CSF或血-脑屏障播散为Ⅴ级。在治疗上,侵袭性垂体腺瘤手术全切困难,术后残留率和复发率高,预后较差。影响垂体腺瘤侵袭性的因素很多,包括 MicroRNAs （ miRNAs）、肿瘤细胞黏附性相关因子、增殖因子、基因突变、垂体瘤新生血管相关因子等。目前为止,侵袭性垂体瘤的发病机理仍处于研究中,其中侵袭性相关生物学标志物一直备受学者关注。     

Galectin-3与垂体泌乳素瘤侵袭性的关系

目的探讨Galectin-3表达和人脑垂体泌乳素(PRL)腺瘤侵袭性的关系。方法应用免疫组织化学技术SP法检测38例垂体PRL腺瘤Galectin-3的表达。结果①侵袭PRL腺瘤与非侵袭PRL腺瘤组的Galectin-3阳性表达率分别为92．0%(23/25)和38．46%(5/13),两组之间差异显著(P＜0．01)。②Galectin-3表达与PRL肿瘤的大小及海绵窦侵袭有关(P＜0．05),但与年龄和性别无明显关系(P＞0．05)。结论Galectin-3与垂体PRL腺瘤侵袭性密切相关,Galectin-3可能在PRL腺瘤的侵袭性生长过程中起重要作用。     

Alteration of prolactin secretion after transsphenoidal adenomectomy for prolactinomas

The author studied the dynamics of prolactin (PRL) secretion after adenomectomy, and considered the treatment for prolactinomas. The study group comprised a total of 74 patients with prolactinomas who underwent transsphenoidal surgery between 1979 and 1986, and 61 patients out of them were followed up more than one year. Post-operatively, hyperprolactinemia was cured (under 20 ng/ml) in 19 of 36 microadenomas (53%), and 7 of 38 macroadenomas (18%). Pre-operatively, PRL response to TRH was blunt except 3 patients, but it recovered in 16 patients after surgery, and 5 more patients during follow-up. Recurrence of hyperprolactinemia occurred in only one of 19 patients who were followed up more than one year, and she was not a PRL responder to TRH. Bromocriptine was administrated to 46 patients after surgery, and hyperprolactinemia was restored to normal in 40 patients. And in 7 patients whose basal PRL levels were between 23 and 41 ng/ml after surgery, hyperprolactinemia was cured still after withdrawal of bromocriptine. During pregnancy, PRL levels were relatively low in surgically cured patients, but in most of others they became over 200 ng/ml promptly after withdrawal of bromocriptine. Recurrence of hyperprolactinemia was rare, and PRL response to TRH recovered in most of surgically cured patients. Even if it is not cured surgically, lowered PRL levels have a good effect on the additional bromocriptine therapy. I prefer transsphenoidal surgery in respect of curative treatment for prolactinomas.     

Brain & chiasmal herniations into sella after medical treatment of prolactinoma

BACKGROUND: Dopamine agonists are widely used in the treatment of pituitary prolactinomas. We report a case of inferior mesial frontal lobe (gyrus rectus) and chiasmal herniations into an enlarged sella following successful medical treatment of a pituitary macroadenoma. METHOD: A 71-year-old healthy man presented to medical attention with visual complaints. On examination, he was found to have bitemporal hemianopsia. Endocrine evaluation revealed an elevated prolactin level. He was treated medically with a dopamine agonist (bromocriptine). RESULTS: Evaluation after one year of medical treatment revealed stabilization of the patient's vision, with a significant bitemporal field loss. Serum prolactin levels normalized (5.16 ng/ml). The MRI of the sella showed almost complete disappearance of the tumor, resulting in right mesial frontal lobe herniation inferiorly into an enlarged sella with associated chiasmal deformation. CONCLUSIONS: We report a case where successful medical treatment of a large pituitary prolactinoma has resulted in inferior frontal lobe and chiasmal herniatons into an enlarged sella.     

侵袭性巨大泌乳素腺瘤的综合治疗（附30例报告）

目的探讨侵袭性巨大泌乳素腺瘤的综合治疗方法及临床治疗效果。方法纳入侵袭性巨大泌乳素腺瘤(IGPs)的标准是:(1)肿瘤直径>4cm;(2)血浆PRL>200ng/ml;(3)高泌乳素分泌或占位效应引起的临床症状。并根据治疗方式的不同分为两组:A组常规的先给以手术治疗,术后给以药物治疗和/(或)放疗,本组18例;B组先给以药物治疗,或配合放疗,必要时再给以手术治疗,本组12例。结果A组失访5例,其余13例在平均随访的42.5个月内肿瘤体积平均缩小76.5%,而B组在随访的23个月内肿瘤体积平均缩小91.3%;肿瘤在MRI上消失A组6例,B组4例;PRL水平控制在200ng/ml以内者A组7例(7/13),B组8例(8/12);A组视力改善者2例(2/13),而B组视力改善者6例(6/12);平均治疗费用A组明显为高。结论对侵袭性巨大泌乳素腺瘤,可先给以药物,能有效地缩小肿瘤体积和控制PRL水平,部分病例可以达到治愈的目的,从而避免手术风险,降低治疗费用。     

The empty sella and pituitary adenomas

In 44 consecutive patients with sellar volume larger than 1100 mm³, computer tomography showed that 20 had an empty or partly empty sella. None had radiological evidence of a suprasellar tumor. 10 of the 20 patients had experienced episodes with acute neurological symptoms presumably reflecting a pituitary apoplexy. It is suggested that an unknown proportion of intrasellar adenomas may disappear as a result of an infarction, which may comprise the entire adenoma or part of it - leaving an empty or partly empty sella as diagnosed by computer tomography. Air encephalography will demonstrate the empty sella only if the diaphragmatic aperture is large enough to allow cisternal herniation. The infarction may present clinically with no, slight or severe acute neurological symptoms. Late consequences of a pituitary adenoma infarction may be rhinorrhea or hydrocephalus.     

Treatment of empty sella syndrome with ventriculoperitoneal shunt.

A symptomatic empty sella developed in a female patient undergoing bromocriptine therapy for microprolactinoma. Placement of a ventriculoperitoneal shunt dramatically improved the symptoms of headache and blurred vision. The post-operative imaging showed resolution of the empty sella. She was able to resume bromocriptine therapy without recurrence of her previous symptoms and give birth to a baby 20 months later. An MRI 44 months after surgery and on bromocriptine therapy showed no recurrence of the empty sella. We conclude that ventriculoperitoneal shunt may be a simple, and durable treatment for drug induced empty sella and allows resumption of bromocriptine therapy for preexisting microprolactinoma.     

Antitumor effect of bromocriptine on estrogen-induced rat prolactinomas: special reference to changes in secretory granules by stereological analysis

Bromocriptine (CB) not only lowers serum prolactin (PRL) levels but also reduces tumor size of human prolactinomas. Gen et al and we have suggested that the size reduction of human prolactinomas by bromocriptine treatment results from the reduction in size of individual tumor cell as well as the reduction in number of tumor cells secondary to cell necrosis. This implies that bromocriptine has a cytosuppressive action and possibly a cytocidal action on human prolactinomas which causes reduction in cell size and cell necrosis, respectively. The mechanism of cytosuppressive action of CB has been investigated by using mostly non-neoplastic pituitary tissues of experimental animals. A decrease in exocytosis of secretory granules and a subsequent accumulation of granules within the cells are suggested to cause the reduction in serum levels of PRL in early stage of CB treatment. However we have reported that in spite of a pronounced reduction of serum PRL levels, the number of exocytosis of the granules in human prolactinomas treated with CB for 2 weeks increased to more than 4 times much as that in the untreated prolactinomas. This is a phenomenon which contradictory to the current hypothesis. The present study is intended to clarify whether the phenomenon we observed is specific for human prolactinomas or common also to the prolactinomas in experimental animals. Seventeen female SD rats were used. They were implanted subcutaneously with a pellet of 20 mg of 17 estradiol-benzoate (20% in cholesterol), and left to grow a pituitary tumor for 10 weeks.(ABSTRACT TRUNCATED AT 250 WORDS)     

Alteration of Gα Subunits mRNA Levels in Bromocriptine Resistant Prolactinomas

Patients with prolactinoma are commonly treated with the D2 dopamine agonist bromocriptine, which in most cases, normalizes prolactin (PRL) levels. However, resistance to bromocriptine has been observed in 5 to 18% of tested prolactinomas and is associated to a decrease in both D2 receptor density and mRNA levels. In this study, we used quantitative RT-PCR to investigate whether expression of G α proteins could be also modified in bromocriptine resistant prolactinomas. No difference in G α o mRNA levels or in the relative expression of G α s between bromocriptine sensitive and bromocriptine resistant prolactinomas was observed. In contrast, the relative expression of G α i₂ was found to be decreased in bromocriptine resistant prolactinomas when compared to that of bromocriptine sensitive prolactinomas. Interestingly, the relative G α i₂ expression was correlated to both bromocriptine inhibition of in vitro PRL secretion and D2 receptor mRNA levels. Bromocriptine resistance could thus result from a decrease in D2 dopamine receptors associated with a decrease in G α i₂ expression.     

溴隐亭治疗垂体泌乳素腺瘤后并发脑脊液漏处理二例报道并文献复习

目的 探讨溴隐亭治疗侵袭性垂体泌乳素腺瘤后并发脑脊液漏的原因、临床表现及处理方法.方法 分析中山大学附属第三医院神经外科收治的2例溴隐亭治疗后并发脑脊液漏的垂体泌乳素腺瘤患者的临床资料,并复习相关文献.结果 2例肿瘤均广泛侵犯颅底,在溴隐亭治疗后1个月内发生脑脊液漏.1例经停药及脑室外引流处理后脑脊液漏停止,另一例经停药、经蝶手术修复漏口及腰大池置管外引流后脑脊液漏停止.在腩脊液漏好转2周后均继续予以较小剂量溴隐亭治疗,随诊3年和9个月无脑脊液漏复发,血泌乳素水平渐下降,肿瘤渐缩小.结论 溴隐亭治疗合并颅底破坏的垂体泌乳素腺瘤时有并发脑脊液漏的可能.停药、手术修复漏口及脑脊液外引流是治疗此类并发症的有效方法.继续小剂量溴隐亭治疗可使肿瘤缓慢缩小并减少脑脊液漏发生的可能.     

Cerebrospinal fluid fistula as the presenting manifestation of pituitary adenoma: case report with a 4-year follow-up

We report the case of a young woman who presented with cerebrospinal fluid (CSF) rhinorrhea due to an undiagnosed and untreated pituitary adenoma. The tumor had extended well beyond sella turcica and caused bony erosion. The patient initially refused surgery and was treated with bromocriptine and a radiation therapy. CSF leakage did not improved and she was submitted to surgery by the transsphenoidal approach with removal of a tumor mass located in sphenoid sinus and sellar region. Origin of the leak was localized and repaired with fascia lata and a lumbar subarachnoid drain was left in place for 5 days. After 4 years she has normal serum PRL levels and no rhinorrhea. The management, complications and mechanisms involved in this rare condition are discussed.     

伽玛刀治疗对垂体泌乳素腺瘤内分泌功能的影响

目的 分析不同放射剂量γ-刀治疗对功能性泌乳素(PRL)腺瘤的PRL水平的影响,判断PRL在γ-刀治疗功能性PRL腺瘤预后和指导激素替代治疗的作用.方法 回顾性分析山东淄博万杰医院和广东深圳罗湖人民医院自2004年9月至2008年3月应用γ-刀治疗的248例功能性PRL腺瘤患者的临床资料,按治疗剂量将患者分组:Ⅰ组:50 Gy≤中心剂量<60 Gy;边缘剂量:20～30 Gy;Ⅱ组:40 Gy≤中心剂量<50 Gy;边缘剂量:15～25 Gy;Ⅲ组:30 Gy≤中心剂量<40Gy;边缘剂量12～20 Gy;术前、术后1月、3月、12月采用放射免疫法检测患者血清PRL水平,术后1年、2年复查头颅MRI观察肿瘤大小的变化.结果 3组患者术前PRL水平的差异有统计学意义(p<0.05),与Ⅰ、Ⅱ组比较,Ⅲ组PRL值偏低,术后12个月与Ⅰ组比较,Ⅲ组PRL值偏高;与术前相比,3组患者术后PRL水平均降低,差异有统计学意义(P<0.05);术后1年MRI显示肿瘤缩小198例(80%);术后2年肿瘤消失203例(82%),增大19例(7.7%),无变化26例(10.4%).结论 不同剂量γ-刀治疗功能性PRL腺瘤对术后内分泌的恢复有很大的影响,中心剂量和边缘剂量(尤其是中心剂量)较高时,术后PRL易恢复正常.但远期是否会造成垂体低功需要长期随访.

Abstract：

Objective To analyze the effects of-γ-knife treatment with different dosages on level of prolactin (PRL) in patients with different sizes of functional pituitary prolactinomas, and determine an index to guide hormone replacement therapy and the prognosis of -γ-knife treatment in patients with functional pituitary prolactinomas through comparing the changes of tumor sizes and the levels of PRL before and after -γ-knife treatment. Methods A retrospective analysis of the clinical data of 248 patients with functional pituitary prolactinomas was performed; gamma knife treatment was performed on these patients from September 2004 to March 2008. We divided the patients into 3 groups: group Ⅰ (50 Gy≤central dose<60 Gy, 20 Gy＜marginal dose<30 Gy), group Ⅱ (40 Gy≤ central dose＜50 Gy, 15 Gy＜marginal dose<25 Gy) and group Ⅲ (30 Gy ≤ central dose<40 Gy, 12 Gy＜marginal dose<20 Gy). The irradiation dose on optic nerves in the 3 groups was under 9 Gy. Radioimmunoassay was employed to detect the serum PRL level before and 1, 3 and 12 months after γ-knife treatment. The changes of the tumor sizes were observed and compared with cranial MRI 1 and 2 years after -γ-knife treatment.Results Significant differences on the PRL level were noted before -γ-knife treatment between each 2 groups (P<0.05); the PRL level in group Ⅲ was lower as compared with that in group Ⅰ and Ⅱ before γ-knife treatment; however, the PRL level in group Ⅲ was higher as compared with that in group 112 months after -γ-knife treatment; the PRL level in all the 3 groups after γ-knife treatment was significantly lower as compared with that before γ-knife treatment (P<0.05). MRI showed that the tumor had 80% partial response rate (198/248) in the 1st year, 82% complete response rate (203/248) in the 2nd year, increased volume in 19 patients (7.7%) and no change in 26 patients (10.4%). Conclusion Different treatment doses of Gamma knife on functional pituitary prolactinomas has great influences on postoperative recovery of endocrine; the higher doses of the center and edge (especially center), the higher normal rate of postoperative PRL level. Whether it will cause long-term hypopituitarism needs continue follow-up.