The Differential Diagnosis Of Prolactinomas And Non-functional Pituitary Adenoma Coexisted With Hyperprolactimia

Objective : The objective of this study is to investigate differential Diagnosis of prolactinoma and non-functional pituitary adenoma coexisted with hyperprolactimia.Methods:This study is a single-center retrospective study,embodies 92 cases admitted by the first affiliated hospital of China medical university from January 2016 to December 2016,in which 55 cases of pituitary prolactin adenoma,37 cases of non-functional adenoma.The items included in the observational study include demographic data(gender,age),preoperative serum prolactin,imaging,postoperative pathology,etc.The population was divided into prolactin adenoma group and non-functional adenoma group according to postoperative immunohistochemistry and serological detection and clinical symptoms.Analyzed based on the preoperative demographic data,serum prolactin level,imaging,and PRL immunohistochemistry after operation.Summarized the differential diagnosis of prolactin adenoma and the non-functional adenoma coexisted with high prolactin.Statistical methods: analysis the quantitative data by normality test,statistical description by the mean number with standard deviation when result is distributed normally,and the independent sample t test was used in the comparison between the two groups.P50(P25,P75)was used for statistical description when the normal distribution was not followed,and the rank and test of two independent samples.The qualitative data were statistically described by frequency,and chi-square test was used for comparison between groups.All statistical analyses were performed in SPSS 25.0,and the test level was 0.05.ROC curve analysis was used to explore the diagnostic value of PRL for prolactin tumor and nonfunctional adenoma coexisted with high prolactin.The ROC curve was drawn in Med Calc 13.0,and the ROC curve parameter was calculated in SPSS25.0.The test level is 0.05.Results:1.The serum prolactin level was significantly different between the two groups(p < 0.05): the group with PRL adenomas was significantly higher than the group with nonfunctional adenoma coexisted with hyperprolactinemia.2.Statistical analysis was conducted on the distribution of prolactin and non-functional adenoma in the patient’s gender and found that there was no statistical difference between the two groups(p > 0.05).3.Patients with non-functional adenoma were older than those with prolactin adenoma.There were significant differences in age between the two groups(p< 0.05).4.Analysis results of ROC curve which is brought into the patient’s serum prolactin levels show that the optimum point is upper 3074 m IU/L,so the PRL level can be thought of the diagnosis of prolactin tumor(or predicted)with moderate accuracy(AUC > 0.7).5.Analyzed the imaging data of the enrolled patients,there was no statistically significant difference between the two groups in the maximum diameter of tumor(p > 0.05).However,all patients with high prolactin in this group were large adenomas or giant adenomas with a saddle growth trend.Conclusion:Prolactinoma associated with high blood prolactin,and part of no-functional pituitary adenomas or large adenoma,with the growth of the saddle extension is also associated with high blood prolactin,and prolactin levels has overlapped "grey area".The serum prolactin level of 3074 m IU/L was used as a reference for the identification of functional prolactin adenoma and non-functional pituitary adenoma with hyperprolactinemia,which is medium accuracy can be used as a reference for clinical diagnosis.But identify the two only by serum prolactin level is not very reliable,It is necessary to differentiate diagnosis by combining imaging with clinical trials,and to identify the experimental treatment of dopamine agonist when necessary.