Endocrine Abstracts

JOINT2316

The aim was to determine the effectiveness of cannulated prolactin test in patients of reproductive age with moderate hyperprolactinemia (HP) and to analyze the frequency of specific and nonspecific complaints.

Materials and Methods: We examined 272 patients, 195w, 77m; age 30.2±9.9 yrs. After cannula insertion, prolactin was measured at 0(PRL0), 60(PRL1), and 120 minutes (PRL2). The results of the cannulated prolactin test (CPT) were considered positive- with HP remaining in all three samples (PRL0, PRL1, PRL2), negative -if HP was at PRL0 and/or PRL1 and without HP in all samples of the test. HP was diagnosed in accordance with the recommendations of the Endocrine Society: >20 ng/ml in men and >25 ng/ml in women. Mild HP is defined in men as a serum prolactin concentration between 19.5 and 100 ng/ml and in women 26.6 and 100 ng/ml.

Results: Median PRL0 was 30.1(21.2-41.2) ng/ml, median PRL1 24.8 (17.5-34.7) ng/ml and median PRL 2 ng/ml 19.5 (13.66-28.9). Approximately 1/3 (30.5%) of the patients reached a normal PRL0. Positive CPT was detected as pathological HP in 37.5% patients. Negative CPT was detected as stress-induced HP in 62.5 % patients. Determination of PRL0 with reference to pathological HP result in a high specificity and moderate sensitivity (sensitivity 54.1%, specificity 100.0%, positive predictive value (PPV) 100.0%, and negative predictive value (NPV) 51.8%, accuracy 69.3%). Determination of PRL1 with reference to pathological HP result in a high specificity and moderate sensitivity (sensitivity 67.1%, specificity 100.0%, positive predictive value (PPV) 100.0%, and negative predictive value (NPV) 71.76%, accuracy 82.1%). 216 patients (73.8 % of women and 79.2 % of men) had complaints, of them patients 161 (57.6 % women and 61 % men) had specific to HP (galactorrhea, menstrual disorders, reduced libido, infertility, gynecomastia, breast pain), 80 patients (25.3 % of women and 30 of men) had non-specific complaints (weight gain, acne, headache, dizziness, scrotum pain, fatigue). The main presenting symptom was gynecomastia in 40.3% of man, and menstrual irregularities in 36.2% of the women.

Conclusion: The cannulated prolactin test was useful in excluding pathological HP, stress-induced HP (negative CPT) was determine in 62.5% of patients. Patients with stress-induced HP (negative CPT) and patients with pathological HP (positive CPT) had no statistically significant differences in age and frequency of occurrence of specific and non-specific complaints and symptoms for HP. Determination of PRL in CPT with reference to pathological HP result in a moderate sensitivity and high specificity.