How to choose relevant examinations for patients with hyperprolactinemia

Hyperprolactinemia is a common pituitary disease. There are no obvious symptoms in the early stage of this disease. The symptoms are very similar to those of general physiological hyperprolactinemia, which can easily lead to delayed treatment. Therefore, it is very important to check for this disease. So, how do patients with hyperprolactinemia choose to do relevant examinations?

The early symptoms of hyperprolactinemia are not obvious, and are similar to the symptoms of general physiological hyperprolactinemia, so patients may easily think that nothing is wrong. Therefore, in this case, it is recommended that patients undergo relevant examinations to ensure their health. The following is an introduction to the examination measures for this disease, which I hope will be useful to everyone.

1. FSH and LH decreased in the hypothalamus-pituitary-ovarian axis reproductive hormone test, and the LH/FSH ratio increased. If PRL ≤ 100ng/ml, it is mostly functional increase, and PRL ≥ 100ng/ml is mostly tumor increase. The larger the tumor, the higher the PRL. For example, if the tumor diameter is ≤ 5mm, the PRL is (171±38)ng/ml; if the tumor diameter is 5-10mm, the PRL is (206±29)ng/ml; if the tumor diameter is ≥ 10mm, the PRL is mostly (485±158)ng/ml. Plasma PRL may not increase when giant adenomas bleed and necrotize.

2. Thyroid, adrenal and pancreatic function tests: When hyperprolactinemia is combined with hypothyroidism, TSH is elevated, and T3, T4, and PBI are decreased. When hyperprolactinemia is combined with Cushing's disease and virilization symptoms, testosterone (T), androstenedione (△4dione), dihydrotestosterone (DHT), dehydroepiandrosterone (DHEA), 17-ketosteroids (17KS) and plasma cortisol are elevated. When hyperprolactinemia is combined with diabetes and acromegaly, plasma insulin, blood glucose, glucagon should be measured and a glucose tolerance test should be performed.

3. Prolactin stimulation test

(1) Thyrotropin-releasing hormone (TRH) test: In normal women, a single intravenous injection of TRH 100-400 pg is given. Within 15-30 minutes, PRL increases 5-10 times compared to before injection, and TSH increases 2 times. There is no increase in patients with pituitary tumors.

(2) Chlorpromazine test: Chlorpromazine inhibits norepinephrine reabsorption and dopamine function through receptor mechanism, and promotes PRL secretion. In normal women, after intramuscular injection of 25-50 mg of chlorpromazine, blood PRL increases 1-2 times compared with before injection 60-90 minutes later and lasts for 3 hours. It does not increase in pituitary tumors.

(3) Metoclopramide test: Metoclopramide promotes the production and release of PRL. In normal women, 30 to 60 minutes after intravenous injection of 10 mg, PRL increases by more than 3 times compared with before injection, but does not increase in patients with pituitary tumors.

4. Prolactin suppression test

(1) Levodopa test: Levodopa is a dopamine precursor that is converted into dopamine by decarboxylase, inhibiting the production and secretion of PRL. In normal women, PRL is significantly reduced 2 to 3 hours after oral administration of 500 mg, but it does not decrease in patients with pituitary tumors.

(2) Bromocriptine test: Levodopa is a dopamine receptor agonist that inhibits the production and release of PRL. In normal women, PRL decreases by more than 50% 2 to 4 hours after taking 2.5 to 5 mg orally, and lasts for 20 to 30 hours. In patients with functional hyperprolactinemia and prolactinoma, prolactin decreases significantly after taking the drug, while GH and ACTH decrease, but GH and ACTH decrease not significantly.

1. Sella CT scan: In normal women, the anterior-posterior diameter of the sella turcica is <17mm, the depth is <13mm, the area is <130mm2, and the volume is <1100mm3. CT scan should be performed if the following images are present: ① sailboat-shaped enlargement; ② double sella turcica bottoms or double edges; ③ high/low density areas or inhomogeneity in the sella turcica; ④ plate deformation; ⑤ calcification foci above the sella turcica; ⑥ osteoporosis of the anterior and posterior clinoid processes; ⑦ cavitation in the sella turcica; ⑧ bone destruction.

2. Magnetic resonance imaging (MRI), cavernous sinus angiography, pneumoencephalography, and cerebral angiography can determine the location and size of the tumor and help differentiate it from other intracranial lesions. Since the false positive and false negative rates of CT diagnosis are 20% and the accuracy rate is only 61%, MRI is recommended for diagnosis.

3. Ophthalmological examination includes visual acuity, visual field, intraocular pressure, and fundus examination to determine whether there are signs of intracranial tumor compression (bitemporal visual field hemianopsia, decreased vision, blindness, nausea, vomiting, and headache, etc.).

The above is an expert introduction to the examination methods for hyperprolactinemia. So many examination methods can make an accurate judgment of the condition. Patients can rest assured about the examination, and must seize the opportunity for future treatment.