MP78-07 PROLACTIN TO TESTOSTERONE RATIO PREDICTS PITUITARY ADENOMAS IN MALE PATIENTS WITH MILD HYPERPROLACTINEMIA

Abstract

You have accessJournal of UrologySexual Function/Dysfunction: Evaluation II (MP78)1 Apr 2020MP78-07 PROLACTIN TO TESTOSTERONE RATIO PREDICTS PITUITARY ADENOMAS IN MALE PATIENTS WITH MILD HYPERPROLACTINEMIA Anup Shah*, Bryan Naelitz, Darren Bryk, Nicholas Farber, Daniel Shoskes, Betul Hatipoglu, and Sarah Vij Anup Shah*Anup Shah* More articles by this author , Bryan NaelitzBryan Naelitz More articles by this author , Darren BrykDarren Bryk More articles by this author , Nicholas FarberNicholas Farber More articles by this author , Daniel ShoskesDaniel Shoskes More articles by this author , Betul HatipogluBetul Hatipoglu More articles by this author , and Sarah VijSarah Vij More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000964.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Mild hyperprolactinemia often prompts pituitary magnetic resonance imaging (pitMRI) in men presenting with hypogonadism; however, the clinical yield of this test is low. We sought to identify a combination of lab results that more accurately predicts clinically significant MRI findings in patients with mild hyperprolactinemia and reduce unnecessary pitMRIs. METHODS: Male patients mild hyperprolactinemia (15-50 ng/ml) who presented with erectile dysfunction, low libido, hypogonadism, or infertility who had undergone pitMRI were included. Those with a prior diagnosis of prolactinoma, hormonal or dopaminergic therapy, or incomplete data were excluded. Symptoms, age, prolactin (PRL), body mass index (BMI), testosterone (T), lutenizing hormone (LH), follicle-stimulating hormone (FSH), thyroid-stimulating hormone (TSH), creatinine (SCr), all medications, and MRI findings were collected. Means of continuous variables were compared with the Wilcoxon-Rank Sum test, and categorical variables were compared with Fisher Exact or Chi-squared tests. Fitted binomial distributions were used to generate Receiver Operating Characteristics (ROCs). RESULTS: 141 men met inclusion criteria. Pituitary adenomas were identified in 35 patients (24.8%) with a median adenoma size of 4 mm (range 1.2 – 38 mm). The ratio of PRL (ng/mL) to T (ng/dL) (PRL/T) outperforms PRL or T alone in predicting positive pitMRI findings (Area Under the Curve (AUC) 0.77 vs 0.70, 0.70 respectively). A PRL/T ratio cutoff >0.1 identified adenomas (p < 0.001) with high sensitivity (83%, 29/35 adenomas identified). 51% of pitMRIs could have been prevented if this metric were applied prior to imaging. A PRL/T ratio cutoff of >0.08 identified adenomas with higher sensitivity 91% (32/35), and 33% of pitMRIs could have been avoided if this metric were applied prior to imaging. CONCLUSIONS: To our knowledge, this study of pitMRI findings among men with hypogonadism and mild hyperprolactinemia is the largest of its kind. The use of PRL/T ratio in lieu of prolactin or testosterone alone retains high sensitivity for identifying patients with prolactinoma (83-91%) and may reduce unnecessary MRIs by up to 51%. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1175-e1176 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Anup Shah* More articles by this author Bryan Naelitz More articles by this author Darren Bryk More articles by this author Nicholas Farber More articles by this author Daniel Shoskes More articles by this author Betul Hatipoglu More articles by this author Sarah Vij More articles by this author Expand All Advertisement PDF downloadLoading ...