Correlation Between MRI Findings of Pituitary Gland and Prolactin Level Among Hyperprolactinemia Adult Female Saudi Patients in Rural Areas: A Retrospective Multicentric Study
Description
A retrospective multicentric study including 4 regions (Alkarj, Afif, Najran, and Riyadh) from western Saudia Arabia between July 2020 and September 2023 including 168 female patients with abnormal prolactin levels who underwent brain MRI for the pituitary gland evaluation. The study excluded patients who had a pacemaker, aneurysm clip, orbital metallic foreign body, prior pituitary disease, severe renal insufficiency, liver cirrhosis, uncompensated primary hypothyroidism, and females on hyperprolactinemic drugs. The correlation between hyperprolactinemia and MRI findings was investigated and analyzed. A receiver operating characteristic (ROC) curve analysis was utilized to determine a serum prolactin threshold value for diagnosing pituitary adenoma in hyperprolactinemic individuals.
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Blood sampling: Blood samples were taken in response to symptoms such as infertility, galactorrhea, amenorrhea, oligomenorrhea, headache, or Visual field defects. The normal serum prolactin level in females was determined to range from 4.79 to 23.3 ng/ml. The blood prolactin level was determined using Chemi-Luminescence. All blood samples were performed between 8:00 and 11:00 a.m. in a quiet room at the endocrine investigation day unit while the patients were fasting. Initially, stable venous access was acquired by inserting an intravenous cannula into an antecubital vein and keeping it patent with a steady infusion of 0.9% normal saline solution. After withdrawing the first prolactin sample from the indwelling cannula, patients remained reclined for 30 minutes. After another 30 minutes, a second prolactin sample was taken, and the lowest prolactin value was used for analysis [1]. Magnetic resonance imaging protocol: MRI was performed on a SIEMENS AVANTO (1.5 Tesla) MRI scanner unit with the following sequences: T1-weighted spin-echo (T1-SE; TR 420, TE 15 ms) with 3 mm contiguous coronal slices; T2-weighted spin-echo (T2-SE; TR 3610, TE 111 ms) with 3mm contiguous coronal slices; and a sagittal T1 acquisition. The field of vision measured 21cm, and the acquisition matrix was 272x320. All individuals were investigated without gadolinium (T1-SE), followed by 0.1mg/kg of gadolinium diethylenetriaminepentaacetic acid (DTPA) administered intravenously right before the acquisition began. Dynamic research was also undertaken. The research was deemed good if the pituitary gland showed a focused region of poor signal on unenhanced images and/or less enhancement than the neighboring gland on contrast-enhanced images. The size of the tumor was determined using hard-copy sagittal and coronal photographs. Maximum sagittal, transverse, and coronal diameters were measured [16]. An adenoma was classified as a microadenoma (a tumor less than 10 mm in diameter) or a macroadenoma (a tumor more than 10 mm in diameter) [1]. Collected data: The collected data include the patient's age, main symptoms, comorbidities such as (hypertension, hypothyroidism, diabetes, lung disease, and adrenal disease), laboratory data such as [Thyroid stimulating hormone (TSH) and prolactin level], and radiologic brain MRI findings. Main outcome: The main outcome was to investigate the correlation between blood prolactin levels and brain MRI findings. The secondary outcome was the association between pituitary adenoma and other clinicopathological characteristics.