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The preoperative and postoperative investigation of TSH and prolactin release in the management of patients with hyperprolactinaemia due to prolactinomas and nonfunctional pituitary tumours: relationship to adenoma size at surgery.
Clin Endocrinol (Oxf). 1986 Apr; 24(4):435-46.CE

Abstract

We report here our results of the pre- and post-operative assessment of prolactin and TSH status in 41 hyperprolactinaemic patients who underwent pituitary surgery over a 5 year period. Preoperatively in patients with prolactinomas (n = 33) the TSH response to domperidone decreased with increasing adenoma size. When the data are expressed on a group mean basis the exaggerated TSH response to domperidone in preoperative prolactinoma patients was reduced significantly in patients rendered normoprolactinaemic by surgery but persisted in those who remained hyperprolactinaemic. Similarly the reduced preoperative PRL responses to domperidone and TRH were significantly increased by successful surgery. In contrast patients with stalk-compression hyperprolactinaemia (n = 6) due to larger lesions which were not prolactinomas all showed reduced or absent TSH responses to domperidone. The PRL responses to domperidone and TRH were reduced or absent both in patients with prolactinomas and in those with stalk-compression hyperprolactinaemia. All patients with stalk-compression hyperprolactinaemia showed a delayed pattern of TSH response to TRH with 60 min values being greater than 20 min ones. In contrast a normal pattern of TSH response to TRH was observed in all patients with hyperprolactinaemia due to prolactinomas. Postoperatively TSH and PRL responses were largely unchanged in patients with stalk-compression hyperprolactinaemia regardless of whether normoprolactinaemia was restored by surgery. In conclusion a reduced or absent PRL response to TRH or domperidone is not diagnostic of the presence of a prolactinoma since it occurs in hyperprolactinaemic patients with prolactinomas or stalk-compression. In contrast, the TSH response to acute dopamine antagonism is exaggerated in most patients with small prolactinomas but not in those with stalk-compression hyperprolactinaemia and we have found this to be helpful diagnostically since the presence of an exaggerated TSH response to dopamine antagonism is evidence against the presence of stalk-compression hyperprolactinaemia. The observation of a delayed TSH response to TRH in a hyperprolactinaemic patient should alert the clinician to the possibility of stalk-compression hyperprolactinaemia due to a large lesion which may not be a prolactinoma.

Authors

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Pub Type(s)

Journal Article

Language

eng

PubMed ID

3091297

Citation

Scanlon, M F., et al. "The Preoperative and Postoperative Investigation of TSH and Prolactin Release in the Management of Patients With Hyperprolactinaemia Due to Prolactinomas and Nonfunctional Pituitary Tumours: Relationship to Adenoma Size at Surgery." Clinical Endocrinology, vol. 24, no. 4, 1986, pp. 435-46.
Scanlon MF, Peters JR, Salvador J, et al. The preoperative and postoperative investigation of TSH and prolactin release in the management of patients with hyperprolactinaemia due to prolactinomas and nonfunctional pituitary tumours: relationship to adenoma size at surgery. Clin Endocrinol (Oxf). 1986;24(4):435-46.
Scanlon, M. F., Peters, J. R., Salvador, J., Richards, S. H., John, R., Howell, S., Williams, E. D., Thomas, J. P., & Hall, R. (1986). The preoperative and postoperative investigation of TSH and prolactin release in the management of patients with hyperprolactinaemia due to prolactinomas and nonfunctional pituitary tumours: relationship to adenoma size at surgery. Clinical Endocrinology, 24(4), 435-46.
Scanlon MF, et al. The Preoperative and Postoperative Investigation of TSH and Prolactin Release in the Management of Patients With Hyperprolactinaemia Due to Prolactinomas and Nonfunctional Pituitary Tumours: Relationship to Adenoma Size at Surgery. Clin Endocrinol (Oxf). 1986;24(4):435-46. PubMed PMID: 3091297.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The preoperative and postoperative investigation of TSH and prolactin release in the management of patients with hyperprolactinaemia due to prolactinomas and nonfunctional pituitary tumours: relationship to adenoma size at surgery. AU - Scanlon,M F, AU - Peters,J R, AU - Salvador,J, AU - Richards,S H, AU - John,R, AU - Howell,S, AU - Williams,E D, AU - Thomas,J P, AU - Hall,R, PY - 1986/4/1/pubmed PY - 1986/4/1/medline PY - 1986/4/1/entrez SP - 435 EP - 46 JF - Clinical endocrinology JO - Clin Endocrinol (Oxf) VL - 24 IS - 4 N2 - We report here our results of the pre- and post-operative assessment of prolactin and TSH status in 41 hyperprolactinaemic patients who underwent pituitary surgery over a 5 year period. Preoperatively in patients with prolactinomas (n = 33) the TSH response to domperidone decreased with increasing adenoma size. When the data are expressed on a group mean basis the exaggerated TSH response to domperidone in preoperative prolactinoma patients was reduced significantly in patients rendered normoprolactinaemic by surgery but persisted in those who remained hyperprolactinaemic. Similarly the reduced preoperative PRL responses to domperidone and TRH were significantly increased by successful surgery. In contrast patients with stalk-compression hyperprolactinaemia (n = 6) due to larger lesions which were not prolactinomas all showed reduced or absent TSH responses to domperidone. The PRL responses to domperidone and TRH were reduced or absent both in patients with prolactinomas and in those with stalk-compression hyperprolactinaemia. All patients with stalk-compression hyperprolactinaemia showed a delayed pattern of TSH response to TRH with 60 min values being greater than 20 min ones. In contrast a normal pattern of TSH response to TRH was observed in all patients with hyperprolactinaemia due to prolactinomas. Postoperatively TSH and PRL responses were largely unchanged in patients with stalk-compression hyperprolactinaemia regardless of whether normoprolactinaemia was restored by surgery. In conclusion a reduced or absent PRL response to TRH or domperidone is not diagnostic of the presence of a prolactinoma since it occurs in hyperprolactinaemic patients with prolactinomas or stalk-compression. In contrast, the TSH response to acute dopamine antagonism is exaggerated in most patients with small prolactinomas but not in those with stalk-compression hyperprolactinaemia and we have found this to be helpful diagnostically since the presence of an exaggerated TSH response to dopamine antagonism is evidence against the presence of stalk-compression hyperprolactinaemia. The observation of a delayed TSH response to TRH in a hyperprolactinaemic patient should alert the clinician to the possibility of stalk-compression hyperprolactinaemia due to a large lesion which may not be a prolactinoma. SN - 0300-0664 UR - https://www.unboundmedicine.com/medline/citation/3091297/The_preoperative_and_postoperative_investigation_of_TSH_and_prolactin_release_in_the_management_of_patients_with_hyperprolactinaemia_due_to_prolactinomas_and_nonfunctional_pituitary_tumours:_relationship_to_adenoma_size_at_surgery_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0300-0664&date=1986&volume=24&issue=4&spage=435 DB - PRIME DP - Unbound Medicine ER -