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The value of PRL in predicting prolactinοma in hyperprolactinemic PCOS

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Kyritsi, Eleni Magdalini, Dimitriadis, Georgios K., Angelousi, Anna, Mehta, Hiten, Shad, Amjad, Mytilinaiou, Maria, Kaltsas, Gregory and Randeva, Harpal S. (2018) The value of PRL in predicting prolactinοma in hyperprolactinemic PCOS. European Journal of Clinical Investigation, 48 (7). e12961. doi:10.1111/eci.12961

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Official URL: http://dx.doi.org/10.1111/eci.12961

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Abstract

Background

To identify a serum prolactin (PRL) cut‐off value indicative of a PRL‐producing adenoma in women with Polycystic Ovarian Syndrome (PCOS) and hyperprolactinemia and characterize such patients.

Materials and methods

In the present retrospective case‐control study the medical records of 528 PCOS women were reviewed. Pituitary magnetic resonance imaging (MRI) was performed in PCOS patients with PRL levels ≥94.0 ng/mL and/or symptoms suspicious of a pituitary adenoma (PA). Prolactinoma diagnosis was made in the presence of an MRI‐identifiable PA with biochemical and radiological response to dopamine agonists. Receiver operating characteristic (ROC) curve analysis was performed to determine a serum PRL threshold that could identify hyperprolactinemic PCOS subjects with prolactinomas. Clinical, metabolic and endocrine parameters were also analysed.

Results

Among 528 patients with PCOS, 60 (11.4%) had elevated PRL levels. Of 44 (73.3%) patients who had pituitary imaging, 19 had PAs, 18 normal MRI and 7 other abnormalities. Patients harboring prolactinomas had significantly higher PRL levels compared to patients without adenomas (median PRL 95.4 vs. 49.2 ng/mL, p<0.0001). A PRL threshold of 85.2 ng/mL could distinguish patients with prolactinomas with 77% sensitivity and 100% specificity [Area Under the curve (AUC) (95%) 0.91(0.8‐1.018), p=0.0001]. PCOS women with prolactinomas were younger and had lower LH levels compared to women without prolactinomas.

Conclusions

In women with PCOS, PRL levels exceeding 85.2 ng/mL are highly suggestive of a prolactinoma warranting pituitary imaging. Pituitary MRI could also be considered in young PCOS patients with milder PRL elevation and low LH levels.

Item Type: Journal Article
Subjects: R Medicine > RG Gynecology and obstetrics
Divisions: Faculty of Medicine > Warwick Medical School > Biomedical Sciences
Faculty of Medicine > Warwick Medical School > Biomedical Sciences > Translational & Experimental Medicine > Metabolic and Vascular Health (- until July 2016)
Faculty of Medicine > Warwick Medical School > Biomedical Sciences > Translational & Experimental Medicine
Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH): Polycystic ovary syndrome -- Treatment, Hyperprolactinemia, Metabolism -- Disorders
Journal or Publication Title: European Journal of Clinical Investigation
Publisher: Wiley-Blackwell Publishing Ltd.
ISSN: 1365-2362
Official Date: July 2018
Dates:
DateEvent
July 2018Published
29 May 2018Available
29 May 2018Accepted
Volume: 48
Number: 7
Article Number: e12961
DOI: 10.1111/eci.12961
Status: Peer Reviewed
Publication Status: Published
Access rights to Published version: Restricted or Subscription Access
RIOXX Funder/Project Grant:
Project/Grant IDRIOXX Funder NameFunder ID
UNSPECIFIEDUnion européenne des médecins spécialistes http://viaf.org/viaf/156564115

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