Can hyperprolactinemia be detected by CT scan?

There is a disease in our lives called hyperprolactinemia. The treatment of this disease is a very difficult problem after the onset of the disease. Why do we say this? This is mainly because the cause of the disease is very complicated and its treatment is more troublesome. So, can hyperprolactinemia be detected by CT?

1. Sella fault

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 phenomena occur: ① ballooning; ② double sella floors or double edges; ③ high/low density areas or inhomogeneity within the sella turcica; ④ saucer-like pattern; ⑤ suprasellar calcifications; ⑥ osteoporosis of the anterior and posterior clinoid processes or cavitation within the sella turcica; and ⑦ bone erosion.

2. Computed tomography (CT) and magnetic resonance imaging (MRI): precise positioning and radiometric measurement of intracranial lesions.

3. Angiography

Includes: intercavernous sinusography, pneumoencephalography and vasoencephalography.

4. Endocrine function test

(I) Pituitary function: FSH and LH decrease, LH/FSH ratio increases, PRL increases ≥ 25ng/ml. It is generally believed that <100ng/ml is mostly functional, and ≥100mg/ml should be used to exclude PRL adenoma. The larger the tumor, the higher the PRL. For example, if the tumor diameter d≤5mm, PRL is 171±38ng/ml; if d=5～10mm206±29ng/ml; ≥10mm485±158ng/ml. PRL may not increase when giant adenoma bleeds and necrotizes.

It should be pointed out that the PRL radiotherapy kit currently used in clinical practice can only measure small molecule PRL (MW 25000), but cannot measure large/large molecule (MW 5-100000) PRL. Therefore, for some patients with obvious clinical symptoms but normal PRL, the so-called occult hyperprolactinemia (occult hyperprolactinemia), that is, large/large molecule hyperprolactinemia, cannot be ruled out.

(ii) Ovarian function test: E2 and P decreased, and T increased.

(III) Thyroid function test: When HPRL is combined with hypothyroidism, TSH increases, while T3, T4, and PBI decrease.

(IV) Adrenal function test: When HPEL is combined with Cushing's disease and virilization symptoms, T, △4dione, DHT, DHEA, 17KS and plasma cortisol are elevated.

(V) Pancreatic function examination: When HPRL is combined with diabetes and acromegaly, insulin, blood sugar, glucagon and glucose tolerance test should be measured.

5. Prolactin function test

(I) Prolactin stimulation test

1. Thyrotropin-releasing hormone test (TRH test): Normal women are given a single intravenous injection of TRH 100-400 μg. 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 the absorption of norepinephrine and the conversion of dopamine through receptor mechanism, and promotes PRL secretion. In normal women, 60 to 90 minutes after intramuscular injection of 25 to 50 mg, the blood PRL increases by 1 to 2 times compared with before injection and lasts for 3 hours. It does not increase in pituitary tumors.

3. Metoclopramide test: This drug is a dopamine receptor antagonist that promotes PRL synthesis and release. 30 to 60 minutes after intravenous injection of 10 mg in normal women, PRL increases by more than 3 times compared with before injection, but does not increase in cases of pituitary tumors.

(II) Prolactin suppression test

1. L-Dopa test: This drug is a dopamine precursor, which generates DA through the action of dehydroxylase and inhibits PRL secretion. Normal women's PRL is significantly reduced 2 to 3 hours after oral administration of 500 mg, but it does not decrease in pituitary tumors.

2. Bromocriptine test: This drug is a dopamine receptor agonist that strongly inhibits PRL synthesis and release. In normal women, PRL decreases by ≥50% 2 to 4 hours after oral administration of 2.5 to 5.0 mm and lasts for 20 to 30 hours. In patients with functional HPRL and PRL adenomas, the decrease is obvious, while the decrease in GH and ACTH is less than that of the former two.

6. Ophthalmological examination includes visual acuity, visual field, intraocular pressure, and fundus examination to determine whether there are any signs of compression caused by intracranial tumors.

The treatments for hyperprolactinemia are those introduced above. These treatments are just some common treatments. For patients, they must go to the hospital for examination and diagnosis before discussing treatment plans with the doctor.