MP27-15 PREVENTING UNNECESSARY PITUITARY MRIS IN HYPOGONADAL AND INFERTILE MEN WITH HYPERPROLACTINEMIA

Abstract

INTRODUCTION AND OBJECTIVE: Hyperprolactinemia is a common laboratory finding in a population of men with symptomatic hypogonadism or infertility. If serum prolactin (PRL) is above the upper limit of normal on two laboratory analyses, current practice is to recommend further workup with a pituitary magnetic resonance imaging (pitMRI) study to assess for a pituitary adenoma. However, this practice pattern may lead to unnecessary healthcare costs secondary to the overutilization of pitMRI. Recent data has suggested serum prolactin:testosterone (PRL/T) ratio may predict pitMRI findings. We sought to examine the cost savings associated with utilizing combinations of serum PRL and serum PRL/T to predict pitMRI positive findings and obviate the need for unnecessary pitMRI. METHODS: We performed a retrospective review of all men <75 years old with infertility or symptomatic hypogonadism who had mild hyperprolactinemia (15-55 ng/ml) and underwent pitMRI at a tertiary care center. Exclusion criteria included a prior pituitary adenoma or symptoms concerning for a pituitary abnormality (e.g. visual changes, galactorrhea). pitMRI findings were reviewed. Baseline clinicodemographic (symptoms, age, BMI, medications) and laboratory variables (PRL, T, LH, FSH, SCr) were collected. Receiver Operating Characteristics and Area Under the Curve metrics were created from fitted binomial distributions. A cost analysis was performed based on the institutional cost of a pitMRI. RESULTS: 136 men met inclusion criteria. Pituitary adenomas were found on pitMRI in 35 men (25.7%). Of the various combinations of serum PRL and PRL/T, PRL/T > 0.10 had greatest specificity while PRL/T > 0.08 OR PRL > 25 had the greatest sensitivity (Table 1). Cost savings were significant for all combinations (Table 1). CONCLUSIONS: The combination of serum PRL and PRL/T correctly predicts the vast majority of pituitary adenomas in patients with mild hyperprolactinemia. Further, this laboratory combination avoids a substantial proportion of unnecessary pitMRIs, resulting in a significant healthcare cost savings. Future clinical guidelines should consider incorporating a screening threshold using serum PRL and PRL/T prior to ordering pitMRI for mild hyperprolactinemia.Source of Funding: None