Central diabetes insipidus and pituitary stalk thickening in adults: distinction of neoplastic from non-neoplastic lesions

Context Association of central diabetes insipidus (CDI) and pituitary stalk thickening (PST) may have several etiologies (including malignancies) and differential diagnosis remains often difficult. Objective The purpose of this study was to identify which clinical, biochemical or radiological features could help clinicians to make an etiological diagnosis, especially distinguishing neoplastic from non-neoplastic pituitary stalk lesions. Design and methods We retrospectively analyzed clinical, biochemical, radiological and histological data of 38 adult patients diagnosed with CDI and PST of proven etiology. Results Of the 38 pituitary stalk lesions included, 11 (29%) were neoplastic. A histopathological diagnosis was obtained in 22/38 (58%) patients. The three most frequently observed etiologies of PST were neuroinfundibulitis (34%), germinoma (21%) and histiocytosis (18%). Pituitary stalk thickness was larger for neoplastic lesions, particularly germinomas. Male gender and a very young age were statistically associated with a risk of germinoma. At least one anterior pituitary deficit was observed in nearly 60% of patients. Patients with neoplastic PST were more affected by multiple anterior pituitary dysfunction than patients with benign PST. A high serum prolactin level was individually the best predictor of a neoplastic origin (90% sensitivity and 60% specificity for a serum prolactin level 1.27-fold above the normal upper limit (ULN)). Conclusion We confirm a relatively high risk of malignancy in adult patients presenting with the association of CDI and PST. Young age, male gender, a very large thickening of the stalk, multiple anterior pituitary deficits and prolactin above 1.3× ULN increase the likelihood of a neoplastic origin.

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Prolactin release in man: influence of cimetidine, thyrotrophin-releasing hormone and acute hypercalcaemia

Acta Endocrinologica ◽

10.1530/acta.0.1020481 ◽

1983 ◽

Vol 102 (4) ◽

pp. 481-485 ◽

Cited By ~ 8

Author(s):

Sven Röjdmark

Keyword(s):

Prolactin Level ◽

Anterior Pituitary ◽

Serum Prolactin ◽

Healthy Individuals ◽

Serum Prolactin Level ◽

Prolactin Release ◽

Thyrotrophin Releasing Hormone ◽

Releasing Hormone ◽

Pre Treatment ◽

Acute Changes

Abstract. The responsiveness of anterior pituitary lactotrophs and thyrotrophs to cimetidine (Cim) was investigated in healthy volunteers. Four-hundred mg Cim, injected iv, raised the serum prolactin level (Prl) from 14 ± 2 to 58 ± 9 ng/ml (P < 0.001), but left the serum thyrotrophin level (TSH) unaffected. Acute hypercalcaemia, induced by iv infusion of calcium, blunted this Cim-elicited Prl response by 35 ± 4% (P < 0.01). Iv injection of 25 μg thyrotrophin-releasing hormone (TRH) had similar Prl-releasing potency as 400 mg Cim, and raised the Prl level from 14 ± 1 to 51 ± 6 ng/ml (P < 0.001). In contrast to Cim, TRH also increased the TSH level significantly. Although oral pre-treatment with Cim for 3 days (1000 mg/day) failed to affect the Prl response to TRH in this study, iv injection of the drug more than doubled the above mentioned Prl response to TRH. The TSH response to TRH remained unaffected both by oral and by iv administration of Cim. These results imply that acute changes in serum calcium affect the release pattern of Prl, and that iv administration of Cim may add Prl-releasing power to TRH in healthy individuals.

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SUN-282 Transient Infundibulohypophysitis in a Child with Central Diabetes Insipidus

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.693 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Shabana Kalladi Puthanpurayil ◽

Ahsan Uddin ◽

Peter Matthew Gerrits

Keyword(s):

Diabetes Insipidus ◽

Anterior Pituitary ◽

Elevated Serum ◽

Central Diabetes Insipidus ◽

Pituitary Stalk ◽

Bright Spot ◽

Neoplastic Process ◽

Anterior Pituitary Function ◽

History Of ◽

Pituitary Stalk Thickening

Abstract Case Description A 7-year-old previously healthy female presented with a 1-month history of tiredness, excessive thirst and increased urinary frequency. Initial studies showed an elevated serum osmolality with relatively dilute urine. She underwent a water deprivation study which confirmed central diabetes insipidus (CDI). An MRI of the brain was obtained which showed markedly thickened and homogeneously enhancing pituitary stalk thickening (17mm craniocaudal x10 mm anteroposterior diameter). Workup did not reveal any signs suggestive of Langerhan’s cell histiocytosis; a skin biopsy and bone survey were normal. A pituitary stalk biopsy was scheduled, however direct endoscopic visualization of the pituitary stalk was normal, so the procedure was aborted. A repeat MRI 7 weeks later showed complete resolution of the stalk thickening. An MRI done 4 months later again showed normal anterior pituitary and normal pituitary stalk, with persistent absent posterior bright spot. She remains on desmopressin, and anterior pituitary functions have been normal to date. Discussion CDI in children can be due to infectious, neoplastic, traumatic or genetic processes that disrupt the hypothalamus or pituitary stalk. One third of children with CDI present with pituitary stalk thickening (PST) on initial evaluation with MRI. There are wide variations in the degree of PST. Previous studies have shown that the degree of PST is different depending on the underlying etiology. Furthermore, regression of PST has been observed in many cases of CDI with PST which has been attributed to idiopathic or autoimmune process (infundibulohypophysitis). Most studies have demonstrated that PST > 4 mm is unlikely to regress and may be more likely to progress with eventual diagnosis of a neoplastic process such as germinoma or Langerhan’s cell histiocytosis. Based on review of the literature, the earliest resolution of PST was in 3 months in a patient who received steroid therapy at diagnosis. [1] Conclusion Our case illustrates that in children with central diabetes insipidus, isolated pituitary stalk thickening may resolve in as short a period as 7 weeks. While ongoing evaluation is warranted with serial pituitary imaging, unnecessary invasive procedures may be avoided in patients without evidence of other underlying anatomic pathology. Anterior pituitary function requires initial and continued surveillance. References 1. Shaefers J et al. Clinical presentation and outcome of children with central diabetes insipidus associated with a self-limited or transient pituitary stalk thickening, diagnosed as infundibuloneurohypophysitis. Clin Endocrinol (Oxf). 2017 Aug;87(2):171-176. doi: 10.1111/cen.13362. Epub 2017 Jun 5.

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SERUM PROLACTINE LEVEL IN PATIENTS OF PSORIASIS VULGARIS AND ITS CORRELATION WITH DISEASE SEVERITY: A CASE-CONTROL STUDY

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v3i6.303 ◽

2019 ◽

Vol 3 (6) ◽

Author(s):

Pawan Kumar Saini ◽

Devendra Yadav ◽

Rozy Badyal ◽

Suresh Jain ◽

Arti Singh ◽

...

Keyword(s):

Disease Severity ◽

Prolactin Level ◽

Case Control Study ◽

Statistical Significance ◽

Case Control ◽

Serum Prolactin ◽

P Value ◽

Serum Prolactin Level ◽

R Value ◽

Control Study

Background: Psoriasis is an autoimmune chronic inflammatory disorder affecting the skin mediated by T-lymphocytes resulting in production of cytokines which cause hyperproliferation of keratinocytes. Several factors and hormones like Prolactin have an action similar to these cytokines in promoting the multiplication of keratinocytes and other cells like lymphocytes and epithelial cells may have a role on the etiopathogenesis of psoriasis. Aim:-The aim of study is to compare the serum Prolactin levels in patients of psoriasis with a control group. Setting and study design: This is a case-control study conducted in the department of Dermatology, Venereology and Leprosy GMC, Kota over a period of 1year from July 2017 to June 2018 Material and method: The study included 100 cases of psoriasis (60 males and 40 females) and 100 controls similar for age and sex. Serum Prolactin levels were measured by ECLIA and results were obtained. Statistical analysis: Mean and standard deviation were calculated for each variable. Statistical significance of the results was analyzed using correlation analysis (Pearson correlation coefficient) and independent samples t-test. Statistical significance was assumed at p value<0.05. Result: Serum Prolactin level was significantly higher in cases of psoriasis compared to controls (p-value <0.001). PASI score and serum Prolactin levels were found to have a positive correlation (r value = 0.337; p-value: 0.001). No significant correlation was found between serum levels of Prolactin and duration of disease r value= -0.034, P value =0.733). Serum Prolactin level was higher in male patients compared to females patients. Conclusion:- High serum Prolactin may be a biological marker of disease severity in psoriasis and may have a role in the pathogenesis of psoriasis. Further studies with large sample size are required to confirm this hypothesis.

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MONITORING OF THE SERUM PROLACTIN LEVEL IN PATIENTS WITH SCHIZOPHRENIA PASSED TO 3 MONTHLY FROM 1 MONTHLY PALIPERIDONE THERAPY

10.26226/morressier.5d1a037957558b317a1408c3 ◽

2019 ◽

Author(s):

Ersin Hatice Karslioglu ◽

ZEYNEP CAKIR ◽

ALİ CAYKOYLU

Keyword(s):

Prolactin Level ◽

Serum Prolactin ◽

Serum Prolactin Level

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Fawzy M. Khalila ,Serum prolactin level as a biological marker of severity in liver cirrhosis.

Benha Medical Journal ◽

10.21608/bmfj.2017.69221 ◽

2017 ◽

Vol 34 (2) ◽

pp. 140-145

Author(s):

Fawzy M. Khalil ◽

Mohamed A. Elassal ◽

Ahmed M. Hussein ◽

Mahmoud Rizk ◽

Mohamed A. Awadein ◽

...

Keyword(s):

Liver Cirrhosis ◽

Prolactin Level ◽

Biological Marker ◽

Serum Prolactin ◽

Serum Prolactin Level

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The association between serum prolactin levels and interleukin-6 and systemic lupus erythematosus activity

Reumatismo ◽

10.4081/reumatismo.2018.1075 ◽

2018 ◽

Vol 70 (4) ◽

pp. 241-250 ◽

Cited By ~ 4

Author(s):

W.A. Wan Asyraf ◽

M.S. Mohd Shahrir ◽

W. Asrul ◽

A.W. Norasyikin ◽

O. Hanita ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Nephritis ◽

Disease Activity ◽

Lupus Erythematosus ◽

Prolactin Level ◽

Serum Prolactin ◽

Systemic Lupus ◽

Serum Prolactin Level ◽

Active Lupus Nephritis ◽

Active Lupus

Based on the recent evidence of association between hyperprolactinemia and systemic lupus erythematosus disease activity (SLEDAI), a study was conducted to analyze the association of hyperprolactinemia with lupus nephritis disease activity. In this cross-sectional study, the analysis was conducted on SLE patients who visited the University Kebangsaan Malaysia Medical Centre (UKMMC) Nephrology Clinic from August 2015 till February 2016. The disease activity was measured using the SLEDAI score, with more than 4 indicating active lupus nephritis. Basal resting prolactin level was analyzed in 43 patients with lupus nephritis, in 27.9% of them had raised serum prolactin. The median of serum prolactin level at 0 minutes was 19.91 ng/mL (IQR: 15.95-22.65 ng/ mL) for active lupus nephritis, which was significantly higher compared to the median of serum prolactin level of 14.34 ng/mL (IQR: 11.09-18.70 ng/mL) for patients in remission (p=0.014). The serum prolactin level positively correlated with SLEDAI (rhos: 0.449, p=0.003) and the UPCI level in lupus nephritis patients (rhos: 0.241, p=0.032). The results were reproduced when the serum prolactin was repeated after 30 minutes. However, the serum prolactin levels at 0 minutes were higher than those taken after 30 minutes (p=0.001). An assessment of serum IL-6 levels found that the active lupus nephritis patients had a higher median level of 65.91 pg/ mL (IQR: 21.96-146.14 pg/mL) compared to the in-remission level of 15.84 pg/mL (IQR: 8.38-92.84 pg/mL), (p=0.039). Further correlation analysis revealed that there was no statistical correlation between the interleukin (IL)-6 levels with serum prolactin, SLEDAI and other lupus nephritis parameters. An ROC curve analysis of serum prolactin at 0 minutes and serum prolactin after 30 minutes and IL-6 levels for prediction of SLE disease activity provided the cutoff value of serum prolactin at 0 minutes, which was 14.63 ng/mL with a sensitivity of 91.7% and specificity of 58.1% and AUC of 0.74 (p=0.015). This study concurred with the previous findings that stated that hyperprolactinemia is prevalent in SLE patients and correlated with clinical disease activity and UPCI level. The baseline of the fasting serum prolactin level was found to be a sensitive biomarker for the evaluation of lupus nephritis disease activity.

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Forbes albright syndrome: galactorrhea–amenorrhea associated with a pituitary tumour: a case report

Journal of Diabetes Metabolic Disorders & Control ◽

10.15406/jdmdc.2021.8.00217 ◽

2021 ◽

Vol 8 (1) ◽

pp. 27-29

Author(s):

Rupak Chatterjee ◽

Prantiki Halder ◽

Sudeshna Mallik ◽

Bibhuti Saha

Keyword(s):

Case Report ◽

Prolactin Level ◽

Pituitary Tumour ◽

Serum Prolactin ◽

Loss Of Consciousness ◽

Pituitary Macroadenoma ◽

Serum Prolactin Level ◽

Mri Brain ◽

Menstrual Irregularities ◽

Albright Syndrome

Forbes Albright syndrome is a hyperprolactinemia syndrome characterised by galactorrhea and amenorrhea associated with a pituitary tumour. Here we report a case of 30 years female who was admitted with menstrual irregularities for 4 months, galatorrhea and headache with recurrent episodes of loss of consciousness for 3months. Her serum prolactin level was highly raised. MRI brain (plain plus contrast) showed enlarged pituitary gland- pituitary macroadenoma. She was diagnosed as a case of Forbes Albright Syndrome and was treated with Tablet Cabergoline. With the medication, size of her tumour markedly reduced and symptoms resolved as she was followed up after 3 months.

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