CT Diagnosis of Hyperprolactinemia

Can CT diagnosis of hyperprolactinemia be performed? The answer is yes, but this alone is not enough. Hyperprolactinemia requires many steps of diagnosis before it can be confirmed, so we need to understand the diagnostic method of hyperprolactinemia. The following is a detailed introduction.

1. Medical history

Emphasis should be placed on understanding menstrual history, marital history, causes and triggers of amenorrhea and galactorrhea, systemic diseases, and history of drug treatment related to HPRL.

2. Physical Examination

Physical examination. Pay attention to the presence of acromegaly, myxedema and other symptoms. Gynecological examination to understand whether the genitals and sexual characteristics are atrophic and have organic lesions. Breast examination to pay attention to size, shape, presence of lumps, inflammatory milk discharge (gently squeeze the breasts with both hands). The characteristics and amount of discharge.

3. Endocrine function test

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

It should be pointed out that the PRL radiation 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 test: When HPRL is combined with diabetes and acromegaly, insulin, blood sugar, glucagon and glucose tolerance test should be measured.

4. Prolactin function test

(I) Prolactin stimulation test

1. Thyrotropin-releasing hormone test (TRH test): normal women receive a single intravenous injection of 100-400 μg of TRH. Within 15-30 minutes, PRL increases 5-10 times and TSH increases 2 times compared to before injection. It does not increase in cases of pituitary tumors.

2. Chlorpromazine test: Chlorpromazine inhibits the absorption of norepinephrine and the conversion of dopamine through receptor mechanism, and promotes the secretion of PRL. 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 that 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 the synthesis and release of PRL. In normal women, PRL increases by more than 3 times 30 to 60 minutes after intravenous injection of 10 mg. It does not increase in pituitary tumors.

(II) Prolactin suppression test

1. L-DOPA test: This drug is a dopamine precursor, which is converted into DA by dehydroxylase and inhibits PRL secretion. In normal women, PRL is significantly reduced 2 to 3 hours after oral administration of 500 mg. It does not decrease in pituitary tumors.

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