CT abnormalities of the pituitary in hyperprolactinaemic women with normal or equivocal sellae radiologically

Pseudotumor artifact of the dorsum sella in CT scanning

Misinterpretation of CT scans in the skull base can result from artifacts due to abrupt density variations of anatomical structure. In this report a wide dorsum sella with low attenuation medullary cavity was initially mistaken on axial scans for an enhancing suprasellar mass. The correct diagnosis was made with follow-up scans based upon thinner cuts, slice angulation negative to the baseline, and reconstructed coronal and sagittal images.

Epidemiology of infertility and polycystic ovarian disease: endocrinological and demographic studies

The frequency of polycystic ovarian disease (PCOD) as a cause of oligo-amenorrhea and infertility was determined, first by characterizing clinically occult PCOD using endocrinological methods, and secondly by estimating the frequency of overt and occult PCOD amongst infertile women residing in a particular area. Four groups of infertile women with oligo-amenorrhea due to 'functional' disorder were compared. The results show that by contrast with the groups having hyperprolactinemia or hypothalamic disorder the group with hirsutism (and therefore presumed PCOD) was closely resembled by a non-hirsute group in terms of estrogenization, LH level, LH/FSH ratio, prolactin level, body mass and responsiveness to clomiphene. The last group was therefore concluded to have a mild occult form of PCOD. The population studies revealed, first, that overt and occult PCOD accounted for 90% of patients with oligomenorrhea and 37% with amenorrhea, or 73% with oligo- or amenorrhea. Oligo- or amenorrhea accounted for 21% of couples with infertility and the annual incidence was 247 patients per million of the general population. The annual incidence of infertility due to PCOD per million was 41 with overt PCOD and 139 with occult PCOD (total 180). Of those, 140 appeared to respond well to clomiphene (78%) but 40 (22%) failed, requiring alternative therapy.

Treatment of presumed prolactinoma by transsphenoidal operation: early and late results

Seventy seven patients who were presumed to have a prolactinoma on the basis of biochemical findings underwent transsphenoidal operation between October 1977 and September 1983. Sixty one patients were found to have a microadenoma, and hyperprolactinaemia was cured in 46 of these, amenorrhoea in 39 (80% of those with the symptom), galactorrhoea in 32 (80%), and infertility in 31 (82%). Four of eight patients found to have a macroadenoma were also satisfactorily treated with surgery. Two patients had a lesion other than a prolactinoma, and in six a tumour could not be found at operation; four of these last eight patients had a normal serum prolactin concentration after operation. Recurrent hyperprolactinaemia was rare, occurring in only three patients in the series overall; among the 32 patients followed up for more than five years only two of the 22 whose operation had initially been successful developed recurrent hyperprolactinaemia.

Facial reflex examination for assessment of trigeminal nerve involvement in pituitary fossa tumours

Sixteen patients with pituitary fossa tumours with different intrasellar extension have been studied by facial reflex examination, a neurophysiological test for the trigemino-facial pathway. Impaired transmission along the reflex path was shown in patients with proved encroachments on the flexible walls of the cavernous sinuses, but with no tumour spread to the brain stem and facial nerve. The findings were consistent with a subclinical involvement of the first trigeminal division. Tumour removal resulted in recovery in nerve conduction. It is concluded that facial reflex examination is a valuable test for detecting cavernous sinus involvement in pituitary fossa tumours.

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

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 with in the hyperprolactinemic patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Computed tomography of sellar and parasellar lesions

The findings in 50 patients examined by computed tomography (CT) of the pituitary fossa are described. The appearances in 43 were judged to be abnormal, four were normal and three were 'doubtful'. Abnormal features included deviation of the pituitary stalk (seven), localised increased enhancement after intravenous injection of contrast medium (18) and extrasellar extension of tumour (11). The CT scans enabled diagnoses of pituitary microadenoma, empty sella and combinations of the two to be made. Modern CT scanners (third or fourth generation) provide detailed information enabling the optimum assessment and treatment of sellar and parasellar lesions.

Long-term phenothiazine treatment does not cause pituitary tumours

In order to explore the possibility that prolactinomas may be caused by prolonged under-inhibition of prolactin-secreting cells we examined the pituitary fossa in 69 patients on long-term phenothiazine treatment. The average duration of treatment was 12.5 years and 55 (80 per cent) of the patients had persistently raised serum prolactin levels. The incidence of radiologically detectable pituitary fossa abnormalities was not significantly different to that in control populations. In 62 per cent of patients the skull x-rays from an earlier admission were available. Comparison of these with earlier films did not show a higher incidence of pituitary fossa abnormalities after prolonged exposure to phenothiazines.