Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
Endocr Pract. 2022 Jun;28(6):572-577. doi: 10.1016/j.eprac.2022.03.013. Epub 2022 Mar 24.
The prolactin levels alone are insufficient to distinguish between some cases of prolactinomas and stalk effect. We aimed to formally characterize the relationship between serum prolactin and prolactinoma volume, determine a cutoff for prolactin/mm that accurately distinguishes prolactinomas from stalk effect, and validate this cutoff in a cohort selected to include ambiguous prolactin values ranging from 50 to 150 ng/mL.
We used the Research Patient Data Registry and transsphenoidal surgery database in our institution to retrospectively identify adult patients with clinically nonfunctioning (NF) tumors (primary analysis, n = 279; validation cohort, n = 10) and prolactinomas (primary analysis, n = 94; validation cohort, n = 18). Solid tumor volumes were measured by Visage 7 software, and cystic foci within tumors were excluded.
Prolactin levels were significantly correlated with prolactinoma volume (r = 0.801) but were not a relevant predictor of NF tumor size (r = 0.015). The prolactin/mm values did not overlap between NF tumors (median, 0.016; interquartile range, 0.009-0.028) and prolactinomas (median, 0.551; interquartile range, 0.265-0.845) (P < .0001). A cutoff of 0.065 ng/mL)/mm correctly discriminated between prolactinomas and NF tumors in all 401 patients in the primary analysis and validation cohort.
The prolactin/volume ratio correctly distinguished all prolactinomas from stalk effect in this study, including a validation cohort specifically chosen for potential ambiguity. To our knowledge, this study is the first formal volumetric analysis of prolactin secretion in pituitary adenomas, and our results suggest that the measurement of prolactin/mm is a valuable tool to better characterize challenging cases of primary tumoral secretion versus secondary hyperprolactinemia due to stalk effect.
仅泌乳素水平不足以区分某些泌乳素瘤和垂体柄效应。我们旨在正式描述血清泌乳素与泌乳素瘤体积之间的关系，确定泌乳素/mm 的截断值，以准确区分泌乳素瘤和垂体柄效应，并在选择的包括 50 至 150ng/ml 范围内的不确定泌乳素值的队列中验证该截断值。
我们使用机构内的研究患者数据注册表和经蝶窦手术数据库，回顾性地确定了患有临床无功能（NF）肿瘤的成年患者（主要分析，n=279；验证队列，n=10）和泌乳素瘤患者（主要分析，n=94；验证队列，n=18）。使用 Visage 7 软件测量实体瘤体积，并排除肿瘤内的囊性病灶。
泌乳素水平与泌乳素瘤体积显著相关（r=0.801），但与 NF 肿瘤大小无相关性（r=0.015）。NF 肿瘤（中位数，0.016；四分位距，0.009-0.028）和泌乳素瘤（中位数，0.551；四分位距，0.265-0.845）之间的泌乳素/mm 值没有重叠（P<0.0001）。在主要分析和验证队列的 401 名患者中，0.065ng/mL/mm 的截断值正确地区分了泌乳素瘤和 NF 肿瘤。
在本研究中，泌乳素/体积比正确地区分了所有的泌乳素瘤和垂体柄效应，包括专门选择的验证队列，以解决潜在的不确定性。据我们所知，这是首次对垂体腺瘤中泌乳素分泌进行正式的体积分析，我们的结果表明，测量泌乳素/mm 是一种有价值的工具，可以更好地描述原发性肿瘤分泌与因垂体柄效应导致的继发性高泌乳素血症之间具有挑战性的病例。
