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Article
Hyperprolactinaemia: when MRI is indicated?

Author: Wasan I. Majeed
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2009 Volume: 8 Issue: 1 Pages: 59-64
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Design This prospective study was carried out at the magnetic resonance imaging (MRI) unit at the department of diagnostic imaging of Al-Kadhmiya Teaching Hospital over a period of 26 months. Objective: To establish a strategy for the use of MRI of the pituitary region in patients with hyperprolactinaemia based on the possibility of finding a pathology in the pituitary region as a cause of hyperprolactinaemia with respect to serum prolactin (PRL) as well as the analysis of serum PRL in relation to the size of adenoma in the pre & post medical treatment evaluation to determine the need for MRI in the follow up in patients with pituitary adenoma. Subjects & Methods We selected 69 women recently found to have clinical & biochemical evidence of hyperprolactinaemia with serum PRL exceeding the double the upper normal level of the control. MRI of the pituitary region & serum PRL were assessed at the initial presentation for all patients & after the institution of bromocriptine (BRC) treatment for 28 patients who were shown to have either micro or macroadenomas at the initial MRI. The diameter of the adenoma served as a predictor for its size & was considered for correlation with serum PRL level at the follow up period of 3 , 6 & 12 months of treatment. Results At the initial MRI, 27 patients had microadenomas (39.1%), 12 patients had macroadenomas (17.4%), 9 patients had empty sella turcica (13.1%), and 21 patients (30.4%) had no obvious abnormality in the pituitary region The analysis of individual serum PRL level to establish a cut-off point of serum PRL above which all cases were positive for a pathology in the pituitary region on MR imaging, revealed a cut-off value = 84.6 ng/ml. A strong correlation has been found between the size of adenoma and serum PRL level at the initial presentation as well as at the follow up assessment that revealed a parallel reduction in adenoma diameter & serum PRL level. Conclusion MRI of the pituitary region is justifiable in women with hyper-prolactinaemia when serum PRL level is approximately two & a half folds of the upper normal level where its likely to reveal an abnormality , but it should not be used routinely for the follow up of patients on treatment as the assessment of serum PRL level will suffice as a predictor of tumor shrinkage unless there is no response to medical treatment or the patient developed new symptoms that suggest increase in the size of the adenoma or involvement of the surrounding structures.


Article
Hyperprolactinaemia: when MRI is indicated?

Authors: Wasan I. Majeed --- Mohammed Abd Kadhim
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2008 Volume: 7 Issue: 2 Pages: 59-64
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Design: This prospective study was carried out at the magnetic resonance imaging (MRI) unit at the department of diagnostic imaging of Al-Kadhmiya Teaching Hospital over a period of 26 months. Objective: To establish a strategy for the use of MRI of the pituitary region in patients with hyperprolactinaemia based on the possibility of finding a pathology in the pituitary region as a cause of hyperprolactinaemia with respect to serum prolactin (PRL) as well as the analysis of serum PRL in relation to the size of adenoma in the pre & post medical treatment evaluation to determine the need for MRI in the follow up in patients with pituitary adenoma. Subjects & Methods: We selected 69 women recently found to have clinical & biochemical evidence of hyperprolactinaemia with serum PRL exceeding the double the upper normal level of the control. MRI of the pituitary region & serum PRL were assessed at the initial presentation for all patients & after the institution of bromocriptine (BRC) treatment for 28 patients who were shown to have either micro or macroadenomas at the initial MRI. The diameter of the adenoma served as a predictor for its size & was considered for correlation with serum PRL level at the follow up period of 3 , 6 & 12 months of treatment. Results: At the initial MRI, 27 patients had microadenomas (39.1%), 12 patients had macroadenomas (17.4%), 9 patients had empty sella turcica (13.1%), and 21 patients (30.4%) had no obvious abnormality in the pituitary region The analysis of individual serum PRL level to establish a cut-off point of serum PRL above which all cases were positive for a pathology in the pituitary region on MR imaging, revealed a cut-off value = 84.6 ng/ml. A strong correlation has been found between the size of adenoma and serum PRL level at the initial presentation as well as at the follow up assessment that revealed a parallel reduction in adenoma diameter & serum PRL level. Conclusion: MRI of the pituitary region is justifiable in women with hyper-prolactinaemia when serum PRL level is approximately two & a half folds of the upper normal level where its likely to reveal an abnormality , but it should not be used routinely for the follow up of patients on treatment as the assessment of serum PRL level will suffice as a predictor of tumor shrinkage unless there is no response to medical treatment or the patient developed new symptoms that suggest increase in the size of the adenoma or involvement of the surrounding structures.


Article
Clinical Outcome of Invasive Pituitary Prolactinomas Treated with Cabergoline

Author: Bassam M Flamerz Arkawazi
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2019 Volume: 15 Issue: 2 Pages: 50-57
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Treatment of invasive prolactinoma, which has several characteristics including invasive growth into cavernous sinuses and formation of giant adenomas compressing adjacent neural structures, resulting in neurological dysfunction, has been very challenging. There are relatively few reports available describing long-term treatment outcome.Aims of the study: In this study we evaluate the results of cabergoline administration as initial treatment during 4 years follow up period.Methods: We prospectively categorized 36 patients into four groups according to the results of 3 months of cabergoline treatment: group 1, tumor volume reduction (TVR) ˃25% with normalized serum prolactin (NP) (n = 24); group 2, TVR˃25% without NP (n = 4); group 3, TVR ˂25% with NP (n = 5); and group 4, TVR ˂25% without NP (n = 3).Results: During follow-up, 22 patients (91.7%) in group 1 achieved TVR˃50% with NP. Three patients (75%) in group 2 achieved TVR˃50% with NP after treatment for 8 months. In group 3, four patients (80.0%) continued medication because of improvement of symptoms and achieved additional TVR(18.8–46.4%). Surgery was performed on five patients (one in group 2, one in group 3, and three in group 4), and complete resection was achieved in four (80.0%). Overall, 25 (69.4%) of the 36 patients treated with cabergoline had complete response and 6 (16.7%) had partial response but did not require surgery. Thus, the overall response rate was 86%,with only five patients (14%) requiring surgical debulking. NP was not achieved by surgery alone in all cases, even after total resection of tumor.Conclusion: Patients who achieve TVR˃25%with NP with 3 months of cabergoline administration had a high possibility of showing good long term response (TVR˃50% with NP) to cabergoline. A higher dose of dopamine agonist (DA) should be considered for patients who achieve TVR˃25% without NP.


Article
FEMALE HYPERPROLACTINEMIA: ANALYSIS OF PRESENTATION AND DIAGNOSTIC EVALUATION. IS PITUITARY MAGNETIC RESONANCE IMAGING ALWAYS INDICATED?
فرط برولاكتين الدم في النساء: دراسة تحليلية للملامح السريرية و تشخيصية للاسباب. هل يتوجب اجراء التصوير بالرنين المغناطيسي دائما؟

Authors: Ayad Sh. Salih اياد صالح --- Sahar L. Halabia سحر لويس حلبية
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2005 Volume: 4 Issue: 1 Pages: 99-110
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Background: Hyperprolactinemia (HPRL) is the most common endocrine disorder of the hypothalamic-pituitary-ovarian axis. The most important and common cause is pituitary tumor.Objectives: 1. Analysis of the presenting features. 2. Role of MRI in the diagnostic evaluation of HPRL. 3. MRI measurements and correlation between MRI findings and serum prolactin concentration (PRL) in Iraqi women. 4. Literature review and work-up for HPRL.Method: clinical assessment, basal PRL and pituitary and cranium MRI performed in a case-series study for 82 Iraqi HPRL female patients attending gynecologic clinic after excluding secondary HPRL.Results: sub-fertility, galactorrhoea and menstrual irregularities were the commonest features. MRI abnormalities found in 41.46% of the patients. 88.24% were pituitary abnormalities. Their PRL was significantly higher than those with idiopathic HPRL (p=0.03). Right pituitary adenomas were more common than the left. The pituitary gland occupied 81.73% of the sella turcica in case of pituitary hyperplasia. There was no significant correlation between adenoma size and PRL (p=077), while there was significant positive correlation between pituitary and sella areas in those with normal MRI (p=0.007) as well as those with pituitary hyperplasia (p=0.04).Conclusion: PRL of 18.5ng/ml considered as the cut-off value to perform high-resolution pituitary and cranium MRI. Primary pituitary hyperplasia may carry a risk of parasellar extension during pregnancy. There is positive correlation between pituitary and sella turcica sizes. MRI considered as the gold-standard imaging method for the pituitary while sella X-ray should be abandoned.Key words: Hyperprolactinemia, Pituitary adenoma, Pituitary hyperplasia, MR imaging, MR measurement, Iraqi

خلفية الدراسة: فرط برولاكتين الدم هو الاكثر شيوعاًً في اضطرابات الغدد الصماء لمحور الوطاء-النخامية-المبيض. حيث تعتبر اورام النخامية من اهم الاسباب و اكثرها شيوعا.هدف الدراسة: تحليل الملامح السريرية. دور التصوير بالرنين المغناطيسي في التقييم التشخيصي لحالة فرط الهرمون. اجراء قياسات بالرنين المغناطيسي مع بيان العلاقة بين نتائج الرنين و نسبة برولاكتين الدم في النساء العراقيات. مراجعة المصادر و اقتراح طريقة اجراءات التشخيص لحالات فرط الهرمون. طريقة العمل: اجري التقييم السريري و القياس الاساسي لتركيز البرولاكتين بمصل الدم و كذلك فحص النخامية و القحف بالرنين المغناطيسي في دراسة تعاقبية ل 82 امرأة عراقية مصابة بفرط البرولاكتين عند مراجعتهن لعيادة الامراض النسائية بعد استبعاد حالات فرط الهرمون الثانوية.النتائج: لقد وجد ان حالات نقص الخصوبة و ثر الحليب و عدم انتظام الدورة الشهرية هي الملامح الشائعة و لقد اظهر الرنين المغناطيسي خللا عند 41.46% من المريضات و كان 88.24% منها بسبب النخامية و التي نتج عنها ارتفاع تركيز البرولاكتين بالدم بصورة معتدة اكثر من الحالات المجهولة السبب P=0.03. كما وجد ان غلّوم النخامية في الجهة اليمنى اكثر من اليسرى. تحتل النخامية 81.73% من مساحة السرج الثركي في حالة فرط التنسج للنخامية. لم تظهر النتائج وجود علاقة معتدة بين حجم الغلوم و مستوى البرولاكتين في الدم و لكن توجد علاقة ايجابية معتدة بين مساحتي النخامية و السرج الثركي في كل من حالة فرط التنسج للنخامية P=0.04 و كذلك حالة الرنين المغناطيسي الطبيعي P=0.07.الاستنتاج : يمكن اعتماد تركيز برولاكتين الدم بقياس 18.5%نغم/مل كحد قاطع لاجراء الرنين المغناطيسي العالي التمييز للنخامية و القحف. ان فرط التنسج للنخامية قد يحمل خطورة الامتداد خارج السرج الثركي اثناء الحمل. هناك علاقة ترابط موجبة بين حجم النخامية و السرج الثركي. ممكن اعتبار الرنين المغناطيسي هو المعيار المذهبي كطريقة لقصور النخامية بينما الصور الشعاعية للسرج الثركي قد بطل استعمالها.مفتاح الكلمات: فرط برولاكتين الدم، غلّوم النخامية، فرط تنسج النخامية، التصوير بالرنين المغناطيسي، قياسات بالرنين المغناطيسي، عراقيات.

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