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The value of prolactin in predicting prolactinοma in hyperprolactinaemic polycystic ovarian syndrome
Author(s) -
Kyritsi Eleni Magdalini,
Dimitriadis Georgios K.,
Angelousi Anna,
Mehta Hiten,
Shad Amjad,
Mytilinaiou Maria,
Kaltsas Gregory,
Randeva Harpal S.
Publication year - 2018
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1111/eci.12961
Subject(s) - hyperprolactinaemia , prolactinoma , medicine , prolactin , endocrinology , receiver operating characteristic , pituitary adenoma , magnetic resonance imaging , adenoma , area under the curve , polycystic ovary , endocrine system , gastroenterology , hormone , radiology , insulin resistance , insulin
Background To identify a serum prolactin ( PRL ) cut‐off value indicative of a PRL ‐producing adenoma in women with polycystic ovarian syndrome ( PCOS ) and hyperprolactinaemia 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 hyperprolactinaemic 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 PA s, 18 normal MRI and 7 other abnormalities. Patients harbouring prolactinomas had significantly higher PRL levels compared to patients without adenomas (median PRL 95.4 vs 49.2 ng/mL, P < .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 = .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.