The value of prolactin in predicting prolactinοma in hyperprolactinaemic polycystic ovarian syndrome

Eleni Magdalini Kyritsi, Georgios K. Dimitriadis, Anna Angelousi, Hiten Mehta, Amjad Shad, Maria Mytilinaiou, Gregory Kaltsas, Harpal S. Randeva

Research output: Contribution to journalArticle

Abstract

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 PAs, 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.

Original languageEnglish
Article numbere12961
JournalEuropean journal of clinical investigation
Volume48
Issue number7
DOIs
Publication statusPublished - 29 May 2018

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Polycystic Ovary Syndrome
Prolactin
Prolactinoma
Magnetic resonance
Imaging techniques
Magnetic Resonance Imaging
Pituitary Neoplasms
Adenoma
Hyperprolactinemia
Dopamine Agonists
Serum
ROC Curve
Area Under Curve
Medical Records
Retrospective Studies
Sensitivity and Specificity

Keywords

  • cut-off
  • hyperprolactinaemia
  • pituitary MRI
  • polycystic ovarian syndrome
  • prolactin
  • prolactinoma

Cite this

Kyritsi, E. M., Dimitriadis, G. K., Angelousi, A., Mehta, H., Shad, A., Mytilinaiou, M., ... Randeva, H. S. (2018). The value of prolactin in predicting prolactinοma in hyperprolactinaemic polycystic ovarian syndrome. European journal of clinical investigation, 48(7), [e12961]. https://doi.org/10.1111/eci.12961
Kyritsi, Eleni Magdalini ; Dimitriadis, Georgios K. ; Angelousi, Anna ; Mehta, Hiten ; Shad, Amjad ; Mytilinaiou, Maria ; Kaltsas, Gregory ; Randeva, Harpal S. / The value of prolactin in predicting prolactinοma in hyperprolactinaemic polycystic ovarian syndrome. In: European journal of clinical investigation. 2018 ; Vol. 48, No. 7.
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abstract = "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 PAs, 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.",
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Kyritsi, EM, Dimitriadis, GK, Angelousi, A, Mehta, H, Shad, A, Mytilinaiou, M, Kaltsas, G & Randeva, HS 2018, 'The value of prolactin in predicting prolactinοma in hyperprolactinaemic polycystic ovarian syndrome', European journal of clinical investigation, vol. 48, no. 7, e12961. https://doi.org/10.1111/eci.12961

The value of prolactin in predicting prolactinοma in hyperprolactinaemic polycystic ovarian syndrome. / Kyritsi, Eleni Magdalini; Dimitriadis, Georgios K.; Angelousi, Anna; Mehta, Hiten; Shad, Amjad; Mytilinaiou, Maria; Kaltsas, Gregory; Randeva, Harpal S.

In: European journal of clinical investigation, Vol. 48, No. 7, e12961, 29.05.2018.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The value of prolactin in predicting prolactinοma in hyperprolactinaemic polycystic ovarian syndrome

AU - Kyritsi, Eleni Magdalini

AU - Dimitriadis, Georgios K.

AU - Angelousi, Anna

AU - Mehta, Hiten

AU - Shad, Amjad

AU - Mytilinaiou, Maria

AU - Kaltsas, Gregory

AU - Randeva, Harpal S.

PY - 2018/5/29

Y1 - 2018/5/29

N2 - 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 PAs, 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.

AB - 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 PAs, 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.

KW - cut-off

KW - hyperprolactinaemia

KW - pituitary MRI

KW - polycystic ovarian syndrome

KW - prolactin

KW - prolactinoma

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UR - https://onlinelibrary.wiley.com/doi/abs/10.1111/eci.12961

U2 - 10.1111/eci.12961

DO - 10.1111/eci.12961

M3 - Article

VL - 48

JO - European journal of clinical investigation

JF - European journal of clinical investigation

SN - 0014-2972

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M1 - e12961

ER -