Prolaktinomas ārstēšanas principi, efektivitāte un pacientu novērošanas taktika Paula Stradiņa Klīniskās universitātes slimnīcā: piecu gadu retrospektīvs pētījums
Loading...
Date
Authors
Advisor
Journal Title
Journal ISSN
Volume Title
Publisher
Latvijas Universitāte
Language
lav
Abstract
Prolaktinoma ir biežākā hormonāli aktīvā hipofīzes adenoma, kuras ārstēšanā galvenā nozīme ir dopamīna agonistiem. Neskatoties uz skaidri definētām vadlīnijām, ārstēšanas efektivitāte un pacientu novērošanas taktika praksē var būt atšķirīga. Šis pētījums analizē terapijas rezultātus un kontroles izmeklējumu biežumu Paula Stradiņa Klīniskajā universitātes slimnīcā. Pētījuma mērķis bija apkopot pacientu vispārējos datus un salīdzināt medikamentozās terapijas taktiku, ilgumu un efektivitāti pacientiem ar prolaktinomu. Kā arī izvērtēt kontroles izmeklējumu atbilstību jaunākajām vadlīnijām prolaktinomas pacientu ārstēšanas procesā. Pētījumā tika atlasīti 74 pacienti ar prolaktinomu, kas ārstējušies PSKUS Endokrinoloģijas centra ambulatorajā daļā no 2020. gada līdz 2024. gadam. No šiem pacientiem 63,5% (n=47) bija sievietes, bet 36,5% (n=27) bija vīrieši. Vidējais vecums prolaktinomas diagnosticēšanas brīdī sievietēm bija 36 gadi, bet vīriešiem – 46 gadi. Turklāt tika konstatēta statistiski nozīmīga saistība starp diagnosticēšanas vecumu un dzimumu (p=0,011), kā arī starp vecumu un prolaktinomas izmēru (p=0,007; r=0,313), liecinot par vāju pozitīvu korelāciju. Lielākajai daļai pacientu (67,6%) tika konstatēta mikroprolaktinoma, kas biežāk sastopama sievietēm (74%; n=37), savukārt makroprolaktinomas novērotas 32,4% pacientu un biežāk sastopamas vīriešiem (58,3%; n=14). Starp dzimumu un audzēja izmēru pastāv statistiski ticama atšķirība (p=0,014), kā arī tika iegūta statistiski nozīmīga saistība starp prolaktīna līmeni serumā un audzēja izmēru (p=0,000), proti, pacientiem ar makroprolaktinomu vidēji konstatēts augstāks prolaktīna līmenis. Pētījuma dati liecina, ka PSKUS endokrinologi 56,7% kā pirmās izvēles terapiju izvēlas bromokriptīnu, savukārt 40,5% pacientu terapiju uzsāk ar kabergolīnu un tikai 2,8% saņēma ķirurģisku terapiju. Kontroles prolaktīna noteikšana pēc terapijas uzsākšanas 70,3% (n=54) tiek nozīmēta pēc 3-4 mēnešiem, 25,7% (n=19) pēc 1-2 mēnešiem un 4% (n=3) pēc 5-6 mēnešiem, kas lielākoties atbilst vadlīnijās noteiktajam. Hipofīzes MRI kontroles izmeklējumi daļēji atbilda vadlīnijām - 96% (n=48) pacientiem tika veikts pēc 12 mēnešiem kopš terapijas uzsākšanas, kas mikroprolaktinomas gadījumā atbilst vadlīnijām, bet makroprolaktinomas gadījumā ir vēlāk nekā rekomendēts. Tādējādi hipotēze, ka PSKUS kontroles izmeklējumi tiek veikti biežāk nekā vadlīnijās noteikts - neapstiprinājās. No 74 pacientiem, kas iekļauti pētījumā, tikai 14,9% pacienti ir pārtraukuši dopamīna agonistu terapiju.
Prolactinoma ir the most common hormonally active pituitary adenoma, which is mainly treated with dopamine agonists. Despite established guidelines, therapy effectiveness and patient monitoring strategies may differ in actual practice. This study analyses Pauls Stradiņš Clinical University Hospital's therapy outcomes and monitoring strategy. The aim of the study was to collect general patient data and compare the tactics, duration and effectiveness of drug therapy in patients with prolactinoma. As well as to evaluate the compliance of control examinations with the latest guidelines in the treatment of patients with prolactinoma. The study selected 74 patients with prolactinoma who were treated in the department of the PSKUS Endocrinology Center from 2020 to 2024. 36.5% (n=27) of these patients were men, while 63.5% (n=47) were women. In addition, a statistically significant association was found between age at diagnosis and gender (p=0.011), as well as between age and prolactinoma size (p=0.007; r=0.313), indicating a weak positive correlation. Microprolactinoma was found in the majority of patients (67.6%), which was more common in women (74%; n=37), while macroprolactinomas were observed in 32.4% of patients and were more common in men (58.3%; n=14). There is a statistically significant difference between gender and tumor size (p=0.014), and a statistically significant relationship was also obtained between serum prolactin levels and tumor size (p=0.000) - prolactin levels were generally higher in patients with macroprolactinoma. The study data show that 56.7% of PSKUS endocrinologists choose bromocriptine as the first-line therapy, while 40.5% of patients negan therapy with cabergoline and only 2.8% received surgical therapy. Follow-up prolactin determination after the start of therapy is prescribed in 70.3% (n=54) after 3-4 months, 25.7% (n=19) after 1-2 months and 4% (n=3) after 5-6 months, which mostly corresponds to the guidelines. Pituitary MRI control examinations partially corresponded to the guidelines - in 96% (n=48) patients it was performed after 12 months from the start of therapy, which in the case of microprolactinoma corresponds to the guidelines, but in the case of macroprolactinoma it is later than recommended. Thus, the hypothesis that PSKUS control examinations are performed more often than specified in the guidelines was not confirmed. Of the 74 patients included in the study, only 14.9% of patients discontinued dopamine agonist therapy.
Prolactinoma ir the most common hormonally active pituitary adenoma, which is mainly treated with dopamine agonists. Despite established guidelines, therapy effectiveness and patient monitoring strategies may differ in actual practice. This study analyses Pauls Stradiņš Clinical University Hospital's therapy outcomes and monitoring strategy. The aim of the study was to collect general patient data and compare the tactics, duration and effectiveness of drug therapy in patients with prolactinoma. As well as to evaluate the compliance of control examinations with the latest guidelines in the treatment of patients with prolactinoma. The study selected 74 patients with prolactinoma who were treated in the department of the PSKUS Endocrinology Center from 2020 to 2024. 36.5% (n=27) of these patients were men, while 63.5% (n=47) were women. In addition, a statistically significant association was found between age at diagnosis and gender (p=0.011), as well as between age and prolactinoma size (p=0.007; r=0.313), indicating a weak positive correlation. Microprolactinoma was found in the majority of patients (67.6%), which was more common in women (74%; n=37), while macroprolactinomas were observed in 32.4% of patients and were more common in men (58.3%; n=14). There is a statistically significant difference between gender and tumor size (p=0.014), and a statistically significant relationship was also obtained between serum prolactin levels and tumor size (p=0.000) - prolactin levels were generally higher in patients with macroprolactinoma. The study data show that 56.7% of PSKUS endocrinologists choose bromocriptine as the first-line therapy, while 40.5% of patients negan therapy with cabergoline and only 2.8% received surgical therapy. Follow-up prolactin determination after the start of therapy is prescribed in 70.3% (n=54) after 3-4 months, 25.7% (n=19) after 1-2 months and 4% (n=3) after 5-6 months, which mostly corresponds to the guidelines. Pituitary MRI control examinations partially corresponded to the guidelines - in 96% (n=48) patients it was performed after 12 months from the start of therapy, which in the case of microprolactinoma corresponds to the guidelines, but in the case of macroprolactinoma it is later than recommended. Thus, the hypothesis that PSKUS control examinations are performed more often than specified in the guidelines was not confirmed. Of the 74 patients included in the study, only 14.9% of patients discontinued dopamine agonist therapy.