Karavitaki Niki, Thanabalasingham Gaya, Shore Helena C A, Trifanescu Raluca, Ansorge Olaf, Meston Niki, Turner Helen E, Wass John A H
Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Headington, Oxford, UK.
Clin Endocrinol (Oxf). 2006 Oct;65(4):524-9. doi: 10.1111/j.1365-2265.2006.02627.x.
The differentiation of a pituitary non-functioning macroadenoma from a macroprolactinoma is important for planning appropriate therapy. Serum PRL levels have been suggested as a useful diagnostic indicator. However, values between 2500 and 8000 mU/l are a grey area and are currently associated with diagnostic uncertainty.
We wished therefore, to investigate the serum PRL values in a large series of patients presenting with apparently non-functioning pituitary macroadenomas.
All patients presenting to the Department of Endocrinology in Oxford with clinically non-functioning pituitary macroadenomas (later histologically verified) between 1990 and 2005 were studied. Information documented in the notes on the medications and on the presence of conditions capable of affecting the serum PRL levels at the time of blood sampling was also collected.
Two hundred and twenty-six patients were identified (median age at diagnosis 55 years, range 18-88 years; 146 males/80 females; 143 gonadotroph, 46 null cell, 25 plurihormonal and 12 silent ACTH adenomas). All tumours had suprasellar extension. At the time of blood sampling 41 subjects were taking medications capable of increasing serum PRL. Hyperprolactinaemia was found in 38.5% (87/226) of the patients. The median serum PRL values in the total group were 386 mU/l (range 16-3257) (males: median 299 mU/l, range 16-1560; females: median 572 mU/l, range 20-3257) and in those not taking drugs capable of increasing serum PRL 363 mU/l (range 16-2565) (males: median 299 mU/l, range 16-1560; females: median 572 mU/l, range 20-2565). Serum PRL < 2000 mU/l was found in 98.7% (223/226) of the total group and in 99.5% (184/185) of those not taking drugs. Among the three subjects with serum PRL > 2000 mU/l, two were taking oestrogen preparations.
Based on a large series of histologically confirmed cases, serum PRL > 2000 mU/l is almost never encountered in nonfunctioning pituitary macroadenomas. Values above this limit in the presence of a macroadenoma should not be surrounded by diagnostic uncertainty (after acromegaly or Cushing's disease have been excluded); a prolactinoma is the most likely diagnosis and a dopamine agonist should be considered as the treatment of choice.
区分垂体无功能大腺瘤和大泌乳素瘤对于制定恰当的治疗方案很重要。血清泌乳素（PRL）水平已被视为一项有用的诊断指标。然而，2500至8000 mU/l之间的值处于灰色地带，目前存在诊断不确定性。
因此，我们希望研究一大组表现为明显垂体无功能大腺瘤患者的血清PRL值。
对1990年至2005年间就诊于牛津内分泌科、临床上诊断为垂体无功能大腺瘤（后来经组织学证实）的所有患者进行研究。还收集了病历中记录的用药信息以及采血时可能影响血清PRL水平的疾病情况。
共识别出226例患者（诊断时的中位年龄为55岁，范围18 - 88岁；男性146例/女性80例；促性腺激素瘤143例、无分泌细胞腺瘤46例、多激素腺瘤25例、沉默促肾上腺皮质激素腺瘤12例）。所有肿瘤均有鞍上扩展。采血时，41名受试者正在服用可使血清PRL升高的药物。38.5%（87/226）的患者存在高泌乳素血症。整个组的血清PRL中位值为386 mU/l（范围16 - 3257）（男性：中位值299 mU/l，范围16 - 1560；女性：中位值572 mU/l，范围20 - 3257），未服用可使血清PRL升高药物的患者的血清PRL中位值为363 mU/l（范围16 - 2565）（男性：中位值299 mU/l，范围16 - 1560；女性：中位值572 mU/l，范围20 - 2565）。整个组中98.7%（223/226）的患者血清PRL < 2000 mU/l，未服用药物的患者中99.5%（184/185）的患者血清PRL < 2000 mU/l。在血清PRL > 2000 mU/l的3名受试者中，2名正在服用雌激素制剂。
基于大量经组织学证实的病例，垂体无功能大腺瘤几乎不会出现血清PRL > 2000 mU/l的情况。在存在大腺瘤的情况下，高于此限值的值不应存在诊断不确定性（排除肢端肥大症或库欣病后）；最可能的诊断是泌乳素瘤，应考虑将多巴胺激动剂作为首选治疗药物。
