2005, Number 3
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Rev Mex Patol Clin Med Lab 2005; 52 (3)
Prolactin releasing tests in hyperprolactinemia: An evaluation of the operational characteristics
Hernández LR, Santana PS, Hung LS, Alonso C, Cabrera OV
Language: Spanish
References: 33
Page: 58-67
PDF size: 205.07 Kb.
ABSTRACT
Rationale: The stimulated Prolactin (Prl)-releasing tests are classical tools of the diagnostic armamentorium of Clinical Endocrinology for the study of hyperprolactinemia associated with hypophyseal tumours. It is believed that a failure to respond to pharmacological stimulation with an increase in the prolactin basal values is patognomonic of the presence of a prolactinoma. However, positive responses have been described in women with radiographical signs of a hypophyseal tumour. On the other hand, negative responses after pharmacological stimulation have been documented in hyperprolactinemic women without radiographical signs of a hypophyseal tumour. These discordant results have lead some researchers to propose the abandonment of these tests.
Objectives: To establish the operational characteristics of the protocols of Thyrotropin-Releasing-Hormone (TRH)- and Cimetidine-stimulated prolactin-releasing tests in hyperprolactinemic women with or without radiographical signs of hypophyseal tumour.
Material and methods: A single intravenous bolus of either 200 mg of TRH or 300 mg of Cimetidine was administered in separate days to: 10 normoprolactinemic women (Group I), 12 women with a hypophyseal adenoma detected by means of Computer Axial Tomography (Group II), and 13 women with a negative radiographical study (Group III). Response to the administration of the bolus was considered as positive if a two-fold increase (or higher) of the basal values of the hormone was observed. The percentages of positive responses in each group of patients were recorded. The operational characteristics of each stimulated prolactin-releasing test were estimated in the following scenarios: Tumour-bearing women vs. Controls; Non-tumour-bearing women vs. Controls; Tumour-bearing vs. Non-Tumour-bearing women. The corresponding ROC curves were constructed. The areas under the constructed ROC curves were calculated.
Results: Response to the bolus administration was as follows: Group I: TRH: 80.0%; Cimetidine: 90.0% (p › 0.05); Group II: TRH: 66.7%; Cimetidine: 83.3% (p › 0.05); Group III: TRH: 61.5%; Cimetidine: 53.8% (p › 0.05). Neither of the pharmaceutical protocols was better than the other in its discriminating capacity, in either of the constructed scenarios. Neither of the pharmaceutical protocols could identify the tumour-bearing, hyperprolactinemic women from those with a negative radiographical study.
Conclusions: Tumour-associated hyperprolactinemia and idiopatic hyperprolactinemia are clinically heterogeneous categories per se, and thus, it can not be expected a pharmacological test to accurately discriminate between these two subpopulations of patients. The results of the pharmacological test should be cautiously interpreted, taking into account the prolactin basal values, the natural evolution of hyperprolactinemia, and the results of the radiographical studies.
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