Moreno Ana, Deza Sara, Salvador Javier, Galofre Juan C, González Álvaro, Alegre Estibaliz
Service of Biochemistry, Clínica Universidad de Navarra, Pamplona, Spain.
Endocrinology Department, Clínica Universidad de Navarra, Pamplona, Spain.
J Appl Lab Med. 2025 Jan 3;10(1):48-58. doi: 10.1093/jalm/jfae123.
In prolactinoma diagnosis, current guidelines recommend prolactin (PRL) assessment, considering values exceeding 200 ng/mL highly suggestive of prolactinoma. However, subtler hyperprolactinemia is more common, and to rule out potential prolactinomas, pituitary resonance magnetic imaging (MRI) studies are necessary. These present limitations in terms of availability, costs, and delays in diagnosis. We aimed to evaluate the screening utility of the metoclopramide (MCP) test in identifying patients with moderate hyperprolactinemia for whom MRI studies might be unnecessary.
We retrospectively selected patients with moderate hyperprolactinemia, with an MCP test and a pituitary MRI within the same assistance, and with no interfering pharmacological treatment. Increases in PRL (ΔPRLMax) and thyrotropin (ΔTSHMax) after MCP infusion were compared according to MRI findings: patients with microadenoma (<10 mm; n = 23), with macroadenoma (≥10 mm; n = 5), or without adenoma (n = 39).
ΔPRLMax exceeds baseline PRL capability to identify patients with an adenoma (area under the curve = 0.872 vs 0.776). ΔPRLMax below 220% identifies 100% of these patients with 71% of specificity. This screening would have avoided 42% of MRI, resulting in a cost savings of 34%. Analysis of ΔTSHMax only slightly increased specificity when considered as a secondary criterion. Test duration can be shortened to 30 min without compromising its screening capability.
A short MCP test is a useful and cost-effective screening tool to avoid unnecessary MRI. Its simplicity allows its performance in almost any clinical facility to easily rule out prolactinoma in an important percentage of patients, something of upmost importance especially in regions where MRI facilities or their access are limited.
在泌乳素瘤的诊断中，当前指南建议进行泌乳素（PRL）评估，认为PRL值超过200 ng/mL高度提示泌乳素瘤。然而，较轻微的高泌乳素血症更为常见，为排除潜在的泌乳素瘤，垂体磁共振成像（MRI）检查是必要的。这些检查在可用性、成本和诊断延迟方面存在局限性。我们旨在评估甲氧氯普胺（MCP）试验在识别中度高泌乳素血症患者中的筛查效用，对于这些患者，MRI检查可能是不必要的。
我们回顾性选择了中度高泌乳素血症患者，这些患者在同一医疗机构内接受了MCP试验和垂体MRI检查，且未接受干扰性药物治疗。根据MRI结果比较MCP输注后PRL（ΔPRLMax）和促甲状腺激素（ΔTSHMax）的升高情况：微腺瘤（<10 mm；n = 23）、大腺瘤（≥10 mm；n = 5）或无腺瘤（n = 39）患者。
ΔPRLMax超过基线PRL的能力可识别腺瘤患者（曲线下面积 = 0.872对0.776）。ΔPRLMax低于220%可识别这些患者中的100%，特异性为71%。这种筛查可避免42%的MRI检查，节省34%的成本。仅将ΔTSHMax作为次要标准进行分析时，特异性略有提高。试验持续时间可缩短至30分钟，而不影响其筛查能力。
简短的MCP试验是一种有用且具有成本效益的筛查工具，可避免不必要的MRI检查。其简便性使其几乎可在任何临床机构进行，能在很大比例的患者中轻松排除泌乳素瘤，这一点尤为重要，特别是在MRI设备或其使用受限的地区。
