Skip to main content
SpringerLink
Log in

The inability of dynamic tests of prolactin and TSH secretion to differentiate between tumorous and non-tumorous hyperprolactinemia

  • Published:
Journal of Endocrinological Investigation Aims and scope Submit manuscript

Abstract

Certain hyperprolactinemic patients have an obvious pituitary tumor while others with normal pituitary radiology may or may not harbor a pituitary microadenoma. A variety of biochemical tests have been proposed to distinguish between those with and those without pituitary tumors. The aims of this study were: firstly to examine these tests to assess their efficacy in differentiating between patients with radiologically-demonstrated pituitary tumors and normal controls; and secondly to establish if those hyperprolactinemic patients with normal radiology formed two distinct groups biochemically as might be expected if some did and some did not have tumors. The prolactin (PRL) and thyroid stimulating hormone (TSH) response to domperidone and the PRL response to TRH and insulin-induced hypoglycemia have thus been examined in hyperprolactinemic subjects with and without radiological evidence of an adenoma and in normal controls. The basal serum PRL was similar in patients with and without radiological evidence of a pituitary adenoma. The serum PRL response to all stimuli studied, expressed as a percentage of initial values, was blunted in patients with known pituitary tumors with total separation from values in control subjects. Results for patients with normal pituitary radiology were similar to those for patients with tumors with minimal overlap with controls. The peak TSH increment after domperidone was exaggerated in patients with known tumors, but overlap with control values was observed in 25%. In patients with normal radiology the peak TSH increment after domperidone was similarly increased but again overlap with control values occurred in 28%. Cluster analysis showed no evidence of two subgroups of response within the hyperprolactinemic patients. For the entire group of patients the PRL responses to agents thought to act at the pituitary (domperidone and TRH) correlated positively with each other and a negative correlation was observed between the TSH and PRL responses to domperidone. The PRL response to hypoglycemia did not correlate significantly with the PRL and TSH responses to other agents. Prolactin responses to domperidone, TRH and hypoglycemia were thus impaired and the TSH response to domperidone exaggerated in hyperprolactinemic females irrespective of pituitary radiology. This suggests either that the dynamic tests studied are ineffective indicators of the presence of a pituitary tumor, or that hyperprolactinemic patients formed a homogeneous group and all harbored a pituitary adenoma.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Cowden E.A., Ratcliffe J.G., Thompson J.A., Macpherson P., Doyle D., Teasdale G.M. Tests of prolactin secretion in diagnosis of prolactinomas. Lancet 1: 1155, 1979.

    Article  PubMed  CAS  Google Scholar 

  2. Crosignani P.G., Ferrari C., Malinvemi A., Barbieri C., Mattei A.M., Caldara R., Rocchetti M. Effect of central nervous system dopaminergic activation on prolactin secretion in man: evidence for a common central defect in hyperprolactinemic patients with and without radiological signs of pituitary tumours. J. Clin. Endocrinol. Metab. 51: 1068, 1980.

    Article  PubMed  CAS  Google Scholar 

  3. Frohman L.A., Berelowitz M., Gonzalez C., Barowsky H., Rao R., Lim V.S., Frohman M.A., Thominet J.L Studies of dopaminergic mechanisms in hyperprolac tinemic states. In: Crosignani P.G., Rubin B.L (Eds.), Endocrinology of human infertility: new aspects. London, Academic Press, 1981, p. 39.

    Google Scholar 

  4. Scanlon M.F., Rodriguez Arnao M.D., McGregor A.M., Weightman D.R., Lewis M., Cook D.B., Gomez-Pan A., Hall R. Altered dopaminergic regulation of thyrotrophin release in patients with prolactinomas: comparison with other tests of hypothalamic-pituitary function. Clin. Endocrinol. (Oxf.) 14: 133, 1981.

    Article  CAS  Google Scholar 

  5. Jacobs H.S., Franks S., Murray M.A.F., Hull M.G.R., Steele S.J., Nabarro J.D.N. Clinical and endocrine features of hyperprolactinaemic amenorrhoea. Clin. Endocrinol. (Oxf.) 5: 439, 1976.

    Article  CAS  Google Scholar 

  6. Ayalon D., Persitz E., Ravid R., Jedwab G., Avidan S., Cordova T., Harell A. The diagnostic value of pharmacodynamic tests in the hyperprolactinaemic syndrome. Clin. Endocrinol. (Oxf.) 11: 201, 1979.

    Article  CAS  Google Scholar 

  7. Biller B.J., Boyd A., Molitch M.E., Post K.D., Wolpert S.M., Reichlin S. Galactorrhea syndromes. In: Post K.D., Jackson I.M.D., Reichlin S. (Eds.), The pituitary adenoma. New York, Plenum, 1980, p. 65.

    Chapter  Google Scholar 

  8. Beastall G.H., Ratcliffe W.A., Ratcliffe J.G., Cohen H.N., Thompson J.A., McCruden D.C., Davies D.L., Teasdale G.M. Thyrotrophin response to metoclopramide in hyperpro-lactinaemic women. Acta Endocrinol (Kbh.) 97: (Suppl. 243) Abstract no. 96, 1981.

    Google Scholar 

  9. Quigley M.E., Yen S.S.C. Evidence for increased dopaminergic inhibition of secretion of thyroid stimulating hormone in hyperprolactinaemic patients with pituitary microadenoma. Am. J. Obstet. Gynecol. 137: 653, 1980.

    PubMed  CAS  Google Scholar 

  10. Robertson W.D., Newton T.H. Radiological assessment of pituitary microadenomas. Am. J. Roentgenol. 131: 489, 1978.

    Article  CAS  Google Scholar 

  11. Reuter A.M., Kennes F., Gevaert Y., Franchimont P. Homologous radioimmunoassay for human prolactin. Int. J. Nucl. Med. Biol. 3: 21, 1976.

    Article  PubMed  CAS  Google Scholar 

  12. Hesch R.D., Evered D.C. Radioimmunoassay of triiodothyronine in unextracted human serum. Br. Med. J. 1: 645, 1973.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  13. Scanlon M.F., Weetman A.P., Lewis M., Pourmand M., Rodriguez Arnao M.D., Weightman D.R., Hall R. Dopaminergic modulation of circadian thyrotrophin rhythms and thyroid hormone levels in euthyroid sub jects. J. Clin. Endocrinol. Metab. 51: 1251, 1980.

    Article  PubMed  CAS  Google Scholar 

  14. Everitt B. Cluster analysis. London, Heinemann, 1980.

    Google Scholar 

  15. Friesep H.G., Tolis G. The use of bromocriptine in the galactorrhoea-amenor-rhoea syndromes: the Canadian cooperative study. Clin. Endocrinol. (Oxf.) 6: (Suppl.) 91s, 1977.

    Google Scholar 

  16. Thomer M.O., Besser G.M. Bromocriptine treatment of hyperprolactinaemic hypogonadism. Acta Endocrinol. (Kbh.) 88: (Suppl. 216) 131, 1978.

    Google Scholar 

  17. Burrow G.N., Wortzman G., Rewcastle N.B., Holgate R.C., Kovacs K. Micro-adenomas of the pituitary and abnormal sellar tomograms in an unselected autopsy series. N. Engl. J. Med. 304: 156, 1981.

    Article  PubMed  CAS  Google Scholar 

  18. Swartz J.D., Russell K.B., Basile B.A., O’Donnell F.G, Popky G.L High resolution computed tomographic appearance of the intrasella contents in women of childbearing age. Radiology 147: 115, 1983.

    PubMed  CAS  Google Scholar 

  19. Quigley M.E., Judd S.J., Gilliland G.B., Yen S.S.C. Effects of a dopamine antagonist oN the release of gonad otropin and prolactin in normal women and women with hyperprolactinaemic anovulation. J. Clin. Endocrinol. Metab. 48: 718, 1979.

    Article  PubMed  CAS  Google Scholar 

  20. Quigley M.E., Judd S.J., Gilliland G.B., Yen S.S.C. Functional studies of dopamine control of prolactin secretion in normal women with hyperprolactinaemic pituitary microadenoma. J. Clin. Endocrinol. Metab. 50: 994, 1980.

    Article  PubMed  CAS  Google Scholar 

  21. Tashjian A.H., Barowsky N.J., Jensen D.K. Thyrotrophin releasing hormone: direct evidence for stimulation of prolactin production by pituitary cells in culture. Biochem. Biophys. Res. Commun. 43: 516, 1971.

    Article  PubMed  CAS  Google Scholar 

  22. Woolf P.D., Lee L.A., Leebaw W., Thompson D., Lilavivathana U., Brodows R., Campbell R. Intracellular glucopenia causes prolactin release in man. J. Clin. Endocrinol. Metab. 45: 377, 1977.

    Article  PubMed  CAS  Google Scholar 

  23. Whitaker M.D., Corenblum B., Taylor P.J., Harasym P.H. Control of the hypoglycaemia release of prolactin. In: L’Hermite M., Judd S.L. (Eds.), Progress in reproductive biology: advances in prolactin. Karger, Basel, 1980, vol. 6, p. 77.

    CAS  Google Scholar 

  24. Masala A., Delitala G., Devilla L., Alagna S., Rovasio P.P. Enhancement of insulin induced prolactin secretion by fluoxetine in man. J. Clin. Endocrinol. Metab. 49: 350, 1979.

    Article  PubMed  CAS  Google Scholar 

  25. Pourmand M., Rodriguez Arnao M.D., Weightman D.R., Hall R., Cook D.B., Lewis M., Scanlon M.F. Domperidone: a novel agent for the investigation of an terior pituitary function and control in man. Clin. Endocrinol. (Oxf.) 72: 211, 1980.

    Article  Google Scholar 

  26. Advis J.P., Hall T.R., Hodson C.A., Mueller G.P., Meites J. Temporal relationship and role of dopamine in “short loop” feedback of prolactin. Proc. Soc. Exp. Biol. Med. 155: 567, 1977.

    Article  PubMed  CAS  Google Scholar 

  27. Cramer O.M., Parker C.R., Porter J.C. Secretion of dopamine into hypophysial portal blood by rats bearing prolactin secreting tumours of ectopic pituitary glands. Endocrinology 105: 636, 1979.

    Article  PubMed  CAS  Google Scholar 

  28. Jaquet P., Grisoli F., Guibout M., Lissitzky J., Carayon P. Prolactin secreting tumours endocrine status before and after surgery in 33 women. J. Clin. Endocrinol. Metab. 46: 459, 1978.

    Article  PubMed  CAS  Google Scholar 

  29. Barbarino A., De Marinis L., Maira G., Menini E., Anile C. Serum prolactin response to thyrotropin releasing hor mone and metoclopramide in patients with prolactin-secreting tumours before and after transphenoidal surgery. J. Clin. Endocrinol. Metab. 47: 1148, 1978.

    Article  PubMed  CAS  Google Scholar 

  30. Schlechte J.A., Sherman B.M. Abnormal regulation of prolactin secretion after successful surgery for prolactin secreting pituitary tumours. Clin. Endocrinol. (Oxf.) 15: 165, 1981.

    Article  CAS  Google Scholar 

  31. Tucker H. St. George, Lankford H.V., Gardner D.F., Blackard W.G. Persistent defect in regulation of prolactin secretion after successful pituitary tumour removal in women with the galactorrhoea-amenorrhoea syndrome. J. Clin. Endocrinol. Metab. 51: 968, 1980.

    Article  PubMed  CAS  Google Scholar 

  32. Lankford H.V., Blackard W.G., Gardner D.F., Tucker H. St. George. Effects of thyrotropin-releasing hormone and metoclopramide in patients with phenothiazine-induced hyper-prolactinaemia. J. Clin. Endocrinol. Metab. 53: 109, 1981.

    Article  PubMed  CAS  Google Scholar 

  33. Jung R.T., White M.C., Bowley N.B., Bydder G., Mashiter K., Joplin G.F. CT abnormalities of the pituitary in hyperprolactinaemic women with normal or equivocal sellae radiologically. Br. Med. J. 2: 1078, 1982.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine (Geriatrics), Newcastle General Hospital, Newcastle upon Tyne, NE4 6BE, England

    R. W. G. Prescott

  2. Department of Medicine, Royal Victoria Infirmary, Newcastle upon Tyne, England

    D. G. Johnston, P. Kendall Taylor, J. Haigh & D. R. Weightman

  3. Department of Neuroradiology, Newcastle General Hospital, Newcastle upon Tyne, England

    K. Hall

  4. Clinical Biochemistry and Metabolic Medicine, Royal Victoria Infirmary, Newcastle upon Tyne, England

    D. B. Cook

Authors
  1. R. W. G. Prescott
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D. G. Johnston
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P. Kendall Taylor
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Haigh
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. D. R. Weightman
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. K. Hall
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. D. B. Cook
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Prescott, R.W.G., Johnston, D.G., Kendall Taylor, P. et al. The inability of dynamic tests of prolactin and TSH secretion to differentiate between tumorous and non-tumorous hyperprolactinemia. J Endocrinol Invest 8, 49–54 (1985). https://doi.org/10.1007/BF03350639

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03350639

Key-words

Search

Navigation