OBJECTIVE This study clarifies the incidence of prolactin-producing pituitary adenomas without hyperprolactinemia and determines the appropriate treatment strategy for these tumors. PATIENTS AND METHODS This retrospective analysis focused on prolactin-producing adenomas without hyperprolactinemia, which were initially treated by surgery as nonfunctioning pituitary adenomas. Among 942 patients with histologically confirmed pituitary adenoma, 114 (12.1 %) patients, consisting of 68 men and 46 women, who had prolactin-producing adenomas without hyperprolactinemia were identified between April 2005 and March 2019. RESULTS Of the 114 patients identified, 13 (11.4 %) had prolactin mono-expressions, 18 (15.8 %) had pit-1 lineage hormonal expressions, and 83 (72.8 %) had paradoxical immunoexpression out of the pituitary differentiation lineage, including prolactin. During the follow-up period, 19 patients suffered tumor progression, and 14 required salvage treatment. Of the 19 patients, 11 underwent gamma knife radiosurgery, and none of them experienced further tumor progression. Cabergoline was administered of them to six patients, and one achieved tumor shrinkage. However, the remaining five patients who were treated with cabergoline suffered further tumor progression and required another salvage treatment. Among the patients in the prolactin mono-expression group, one experienced tumor regrowth and underwent gamma knife radiosurgery. In the pit-1 lineage group, two patients experienced tumor regrowth. One had further tumor progression after treatment with cabergoline and underwent gamma knife radiosurgery. Among the patients in the paradoxical immunoexpression group, 16 suffered tumor progression. Four patients underwent further surgery, seven patients were treated with gamma knife radiosurgery, and one patient received fractionated irradiation. None of the eight patients who were treated with gamma knife radiosurgery and fractionated irradiation showed further tumor progression. Four patients in this group were treated with cabergoline, but they all suffered further tumor progression and underwent additional salvage treatments. CONCLUSIONS Out of the pituitary differentiation lineage, paradoxical hormonal expression occurred in three-quarters of the patients identified. Further surgery or gamma knife radiosurgery should be given priority in times of tumor progression because most patients were resistant to dopamine agonists.

中文翻译：

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无高泌乳素血症的催乳素产生垂体腺瘤的单中心经验：其发病率和临床管理

目的 本研究阐明没有高催乳素血症的产生催乳素的垂体腺瘤的发病率，并确定这些肿瘤的适当治疗策略。患者和方法 本回顾性分析侧重于无高催乳素血症的产催乳素腺瘤，这些腺瘤最初作为无功能垂体腺瘤通过手术治疗。2005 年 4 月至 2019 年 3 月期间，在 942 名经组织学证实的垂体腺瘤患者中，有 114 名（12.1 %）患者（包括 68 名男性和 46 名女性）患有催乳素腺瘤，但没有高催乳素血症。 结果 在确定的 114 名患者中，有 13 ( 11.4 %) 具有催乳素单表达，18 (15.8 %) 具有 pit-1 谱系激素表达，83 (72.8 %) 具有垂体分化谱系之外的反常免疫表达，包括催乳素。随访期间，19例患者出现肿瘤进展，14例需要挽救治疗。在 19 名患者中，11 名接受了伽玛刀放射外科手术，并且没有人经历了进一步的肿瘤进展。将卡麦角林给予 6 名患者，其中一名患者肿瘤缩小。然而，其余 5 名接受卡麦角林治疗的患者出现了进一步的肿瘤进展，需要再次抢救治疗。在催乳素单表达组的患者中，一名患者经历了肿瘤再生并接受了伽马刀放射外科手术。在 pit-1 谱系组中，两名患者经历了肿瘤再生。一个在用卡麦角林治疗后肿瘤进一步进展并接受了伽马刀放射外科手术。在矛盾免疫表达组的患者中，16 人患有肿瘤进展。4 名患者接受了进一步手术，7 名患者接受了伽玛刀放射外科治疗，1 名患者接受了分次照射。接受伽马刀放射外科手术和分次照射治疗的八名患者均未出现进一步的肿瘤进展。该组中的四名患者接受了卡麦角林治疗，但他们都遭受了进一步的肿瘤进展并接受了额外的挽救治疗。结论 在垂体分化谱系中，四分之三的患者出现了矛盾的激素表达。在肿瘤进展时应优先考虑进一步手术或伽玛刀放射外科手术，因为大多数患者对多巴胺激动剂有抵抗力。7 名患者接受了伽玛刀放射外科治疗，1 名患者接受了分次照射。接受伽马刀放射外科手术和分次照射治疗的八名患者均未出现进一步的肿瘤进展。该组中的四名患者接受了卡麦角林治疗，但他们都遭受了进一步的肿瘤进展并接受了额外的挽救治疗。结论 在垂体分化谱系中，四分之三的患者出现了矛盾的激素表达。在肿瘤进展时应优先考虑进一步手术或伽玛刀放射外科手术，因为大多数患者对多巴胺激动剂有抵抗力。7 名患者接受了伽玛刀放射外科治疗，1 名患者接受了分次照射。接受伽马刀放射外科手术和分次照射治疗的八名患者均未出现进一步的肿瘤进展。该组中的四名患者接受了卡麦角林治疗，但他们都遭受了进一步的肿瘤进展并接受了额外的挽救治疗。结论 在垂体分化谱系中，四分之三的患者出现了矛盾的激素表达。在肿瘤进展时应优先考虑进一步手术或伽玛刀放射外科手术，因为大多数患者对多巴胺激动剂有抵抗力。接受伽马刀放射外科手术和分次照射治疗的八名患者均未出现进一步的肿瘤进展。该组中的四名患者接受了卡麦角林治疗，但他们都遭受了进一步的肿瘤进展并接受了额外的挽救治疗。结论 在垂体分化谱系中，四分之三的患者出现了矛盾的激素表达。在肿瘤进展时应优先考虑进一步手术或伽玛刀放射外科手术，因为大多数患者对多巴胺激动剂有抵抗力。接受伽马刀放射外科手术和分次照射治疗的八名患者均未出现进一步的肿瘤进展。该组中的四名患者接受了卡麦角林治疗，但他们都遭受了进一步的肿瘤进展并接受了额外的挽救治疗。结论 在垂体分化谱系中，四分之三的患者出现了矛盾的激素表达。在肿瘤进展时应优先考虑进一步手术或伽玛刀放射外科手术，因为大多数患者对多巴胺激动剂有抵抗力。发现的四分之三的患者出现了矛盾的荷尔蒙表达。在肿瘤进展时应优先考虑进一步手术或伽玛刀放射外科手术，因为大多数患者对多巴胺激动剂有抵抗力。发现的四分之三的患者出现了矛盾的荷尔蒙表达。在肿瘤进展时应优先考虑进一步手术或伽玛刀放射外科手术，因为大多数患者对多巴胺激动剂有抵抗力。