Abstract
Preoperative diagnosis of prolactinomas is critical because dopamine agonists have been regarded as a primary treatment. However, serum prolactin level alone is suboptimal for differentiating prolactinomas from hyperprolactinemia-causing non-functioning pituitary adenomas (NFPAs). By using the tumor size, the authors tried to investigate an effective parameter for the discrimination. We performed a retrospective review of patients who underwent trans-sphenoidal surgery for pituitary lesions in a single institute between January 2015 and May 2021. Using receiver operating curve (ROC) analyses, we compared performances of serum prolactin levels (PRL), a ratio of serum PRL levels to maximal tumor diameter (MD) (PRL/MD; PDR1), and MD squared (PRL/[MD]2; PDR2) in preoperative diagnosis of prolactinomas. A total of 223 patients with NFPAs (n= 175) and prolactinomas (n= 48) were included in the analysis. A moderate correlation was found between serum prolactin levels and MDs in prolactinomas (Pearson's rprl= 0.43, P= 0.002), whereas a weak correlation was observed in NFPAs (Pearson's rnfpa= 0.17, P= 0.028). Among diagnostic parameters, PDR2 exhibited the optimal diagnostic performance with the cutoff value of 0.83 [㎍/L]/mm2 (area under the curve [AUC]= 0.945), compared with the PDR1 (8.93 [㎍/L]/mm with AUC 0.938) and PRL (99.4 ㎍/L with AUC 0.910). In the external validation study, PDR2 maintained superior performance over PDR1 and PRL (accuracy of 94.8%, 91.8%, and 75.8%, respectively). PDR2 was a more effective indicator than prolactin alone in the preoperative differential diagnosis of prolactinomas and NFPAs, which may help select patients who need medical treatment first.
Highlights
Prolactinoma is the most common type of pituitary adenoma (PA), accounting for 32-66% of all pituitary tumors requiring treatment
This study investigated the predictive value of PRL and PDR for preoperative differentiation of prolactinomas and non-functioning pituitary adenomas (NFPAs)
Distinguishing these two pathologies is critical given the satisfactory response to dopamine agonists (DAs) in prolactinomas and the need for surgical resection in large NFPAs
Summary
Prolactinoma is the most common type of pituitary adenoma (PA), accounting for 32-66% of all pituitary tumors requiring treatment. The preoperative diagnosis of prolactinomas has been a matter of debate because of other pituitary pathologies accompanied by hyperprolactinemia. Hyperprolactinemia is defined as serum prolactin (PRL) levels above the upper reference limit (commonly >20 μg/L in men and >25 μg/L in women), with different physiological, pharmacological, and pathological causes[4,5,6]. Though prolactinoma is the most common cause of the prolactin hypersecretion in PAs, the “stalk section effect” of non-functional pituitary adenomas (NFPAs), the mechanical compression of the stalk blocks dopamine inhibition of lactotroph, makes it challenging to discriminate prolactinomas [4,7,8,9]
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