Laporan Kasus: Perbaikan Kadar Prolaktin pada Makroadenoma Hipofisis dengan Terapi Bromokriptin dan EETA

N. P. L. Gayatri, H. B. Hidayati
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引用次数: 2

Abstract

Hiperprolaktinemia merupakan salah satu gejala klinis yang umum terjadi pada kasus makroadenoma hipofisis. Hiperprolaktinemia yang terjadi pada makroadenoma hipofisis dapat disebabkan oleh adanya penekanan massa tumor terhadap infundibulum ( pituitary stalk ) atau pun adanya sekresi hormon oleh tumor. Penelitian ini bertujuan untuk membahas pengaruh pemberian terapi bromokriptin dan operasi Endoscopic Endonasal Transsphenoidal Approach (EETA) terhadap perbaikan kadar hormon prolaktin dan kondisi klinis pada kasus makroadenoma hipofisis dengan hiperprolaktinemia. Dalam laporan kasus ini, dilaporkan bahwa seorang remaja pria usia 17 tahun datang dengan hilangnya penglihatan mata kanan, nyeri kepala, sulit menelan, dan ginekomasti. Pemeriksaan Magnetic Resonance Imaging (MRI) otak dengan kontras didapatkan adanya lesi ekstra aksial supratentorial di intrasellar yang meluas hingga suprasellar. Pada pemeriksaan laboratorium didapatkan adanya hiperprolaktinemia 198,10 ng/mL (nilai referensi 2,1–17,1 ng/mL). Hiperprolaktinemia yang terjadi pada kasus ini dapat disebabkan oleh tumor hipofisis yang mensekresi prolaktin (prolaktinoma) dan/atau akibat dari pendesakan massa tumor terhadap infundibulum. Berdasarkan hasil anamnesis, pemeriksaan fisik, pemeriksaan laboratorium dan penunjang, pasien didiagnosis mengalami makroadenoma hipofisis. Kami mempresentasikan kasus perbaikan kondisi klinis dan total penurunan kadar prolaktin sebesar 79,70% (pre pengobatan 198,10 ng/mL, post pengobatan 40,20 ng/mL) pada pasien dengan makroadenoma hipofisis yang disertai hiperprolaktinemia setelah dilakukan pemberian terapi bromokriptin 2,5 mg per hari selama 14 hari masa perawatan di rumah sakit dan tindakan operasi EETA. Kata kunci: Bromokriptin, ginekomasti, hiperprolaktinemia, makroadenoma hipofisis A Case Report: Prolactin Levels Improvement in Pituitary Macroadenoma with Bromocriptine Therapy and EETA Abstract Hyperprolactinemia is one of the common clinical symptoms of pituitary macroadenoma. Hyperprolactinemia that occurs in pituitary macroadenoma can be caused by the suppression of the tumor mass against the infundibulum (pituitary stalk) or due to hormone secretion by the tumor. This study aims to discuss the effect of bromocriptine therapy and Endoscopic Endonasal Transsphenoidal Approach (EETA) surgery on prolactin level and clinical conditions in pituitary macroadenoma with hyperprolactinemia. This case report presents a seventeen years old boy with loss of right eye vision, headache, swallowing difficulty, and gynecomastia. Brain Magnetic Resonance Imaging (MRI) scan with contrast media found an extra-axial supratentorial lesions extending to the suprasellar. Also, based on laboratory examination, hyperprolactinemia was found with prolactin level of 198.10 ng/mL (reference value 2.1–17.1 ng/mL). Hyperprolactinemia that occurred in this case was found to be caused by a prolactin-secreting pituitary tumor (prolactinoma) towards the infundibulum. Based on the anamnesis, physical examination, laboratory test, and MRI, the patient was diagnosed of pituitary macroadenoma. An improvement was also observed in clinical conditions, where prolactin levels decreased by 79.70% (pre and post treatment 198.10 ng/mL and 40.20 ng/mL, respectively) after 2.5 mg bromocriptine therapy administration for 14 days and EETA surgery therapy. Keywords: Bromocriptine, gynecomastia, hyperprolactinemia, pituitary macroadenoma
病例报告:使用溴隐亭和 EETA 治疗改善垂体大腺瘤患者的泌乳素水平
在脑垂体黄瘤病例中,多菌性是常见的临床症状之一。脑垂体红血瘤的增生增生可能是由于肿瘤抑制皮囊或肿瘤分泌激素的结果。本研究旨在探讨溴黄素疗法和内孔替替手术对促红细胞生成素水平的改善和高丙戊酸中毒临床情况的影响。据报道,一名17岁的年轻男子出现时右眼失明、头痛、吞咽困难和妇科医生。通过对大脑进行磁共振造像(MRI)的对比,大脑内部的宽状上存在额外的上轴损伤。在实验室检查中,您发现了高丙基提米198.10日/mL(参考值2,1 - 17.1 ng/mL)。在这种情况下发生的超生血症可能是由于促红细胞生成素分泌的脑垂体肿瘤和/或是肿瘤向无功能障碍的缺乏的结果。根据分析结果、物理检查、实验室检查和支持,患者被诊断为脑垂体瘤。我们临床状况改善的情况介绍和prolaktin水平下降总额为79,70% (pre 198.10 ng / mL,邮报40,20疗法对病人的脑下垂体makroadenoma ng / mL)伴随着hiperprolaktinemia做礼物后每天bromokriptin 2.5毫克治疗14天EETA手术在医院的治疗和行为。关键字:bromocriphtin,妇科masti,高丙胺,脑垂体麻醉甲状腺瘤的高丙酸血症可以由肿瘤抑制的肿块或由肿瘤分泌的激素分泌引起。这项研究揭示了溴criptine疗法和内镜内分泌的转移效应和高丙戊酸铅中毒的临床条件。这份案例报告展示了一个失去右眼、头痛、吸水困难的17年的老男孩。大脑磁共振成像(MRI)扫描结果发现,一种高传染性的、垂体的垂体延伸到上层。此外,基于实验室调查,超丙三是由198.10 n /mL的prolactinsand水平发现的。在这种情况下发生的高丙酸血症是被一种前期肿瘤分泌的。根据分析,物理考察,实验室测试和核磁共振成像,病人被诊断出脑动脉瘤。其中包括观察临床条件,在治疗2.5毫克bromocriptine therapy 14天EETA治疗后,经79.70%的恶化(pre and post decreation 198.10 h /mL和40.20 ng/mL, respectiy)。溴criptine, gynecomastia,高丙酸西米亚,黄斑脑垂体
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