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Background: The clinical studies reported more invasive pituitary adenomas at home and abroad, the but no giant multi-directional invasive pituitary adenomas study, the giant multi invasive pituitary adenoma (Giant the Multidirectional Invasive Pituitary Adenomas GMIPAs) refers to the diameter gt; 4cm, invasive pituitary adenoma growth to a single, bilateral cavernous sinus and temporal lobe, the sphenoid sinus and nasal cavity, frontal cortex, hypothalamus, slopes and posterior fossa in six directions at least three directions. These tumors, surgery can not be wholly removed, often require multiple surgeries, comprehensive treatment of postoperative radiotherapy, drugs, treatment is difficult. In this study, through the study of such pituitary adenoma, summed clinical characteristics of GMIPAs, and explore the comprehensive treatment program. Methods: 34 cases Xiangya Hospital diagnosed giant multi invasive pituitary adenoma cases, given drugs, surgery, radiotherapy treatment, observe the clinical manifestations, changes in endocrine hormone levels and tumor volume indicators were reviewed multivariate analysis. Results: 34 cases GMIPAs, PRL tumors 16 cases, pre-treatment PRL values: 200.00ng/ml 83410.00ng/ml after treatment the PRL values: 3.68ng/ml-2220.22ng/ml; non-PRL tumors 18 cases, PRL value: 0.18ng/ml 90.35ng/ml treatment PRL values: 0.35ng/ml ~ 43.63ng/ml. Of all GMIPAs before treatment volume: 9.14cm3 ~ 224.00cm3. The tumor invasion three directions 2 patients (5.9%), the four directions in 7 cases (20.6%), 13 cases (38.2%), 6, 5 direction direction in 12 cases (35.3%). Supratentorial obstructive hydrocephalus in 4 cases (11.8%), tumor cystic degeneration in 6 cases (17.6%), 5 cases (14.7%) tumor apoplexy. GMIPAs size and degree of visual field defects no correlation. Multivariate Logistic regression analysis found negative correlation of estradiol with sexual dysfunction; occurrence of sexual dysfunction with gender, age has nothing to do. PRL the type GMIPAs of PRL value no correlation with tumor volume, and treatment, the maximum diameter of the tumor after a positive correlation. The PRL gene found no significant difference between the treatment effect of non-PRL gene GMIPAs integrated treatment GMIPAs patients. The number of different invasion direction GMIPAs patients with treatment outcome difference was not statistically significant. Order bromocriptine treatment alone the PRL type GMIPAs its tumor shrinkage is the saddle narrow part of the tumor first, followed the invasion of the surrounding parts of the temporal lobe, saddle parts, and finally the outer portion of the internal carotid artery in the cavernous sinus. Conclusion: 1.GMIPAs is common PRL and no functional. The most common symptoms of 2.GMIPAs visual acuity, visual field damage, but GMIPAs vision, vision impaired, and the relationship between tumor size is not clear, and is closely related to tumor growth direction. 3.GMIPAs patients, estradiol and sexual function disorders are closely related, was negatively correlated with the function of estrogen is a protective factor. 4.PRL type GMIPAs treatment before the maximum diameter of PRL value, the maximum diameter was positively correlated with PRL values ??after treatment. 5.PRL type and non-PRL type GMIPAs of treatment effect between no difference. 6 between the treatment effect in a number of different invasion direction GMIPAs no difference. 7.PRL type sequence GMIPAs service bromocriptine treatment tumor shrinkage regularity. 8.PRL type GMIPAs preferred bromocriptine treatment, short-term tumor shrinkage, adhere to drug therapy may achieve clinical cure. 9. Non-PRL GMIPAs should surgical resection postoperative radiotherapy treatment based.
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