MRI of sellar and suprasellar regions in hyperprolactinemia

Abstract EN

Purpose: To illustrate the value of MR imaging in detecting the presence of underlying causes of hyperprolactinemia and as a guide for selection of the appropriate therapeutic and management plans.

Material and Methods: The study' included 40 patients, aged between 12-75 years, 29 women and 12 men, presented with hyperprolactinemia.

MR imaging for the sella and brain was made for all patients before and after I.V.

injection of Gd-DTPA, using 1.5 Tesla magnet (G.E.

Sign).

Serum prolactin level was measured on Roche Elecsys immunoanalyzer - Reference values for man is 86-390 mlU/L andfor woman is 72-511 mlu/L.

Results : Macroadenomas were detected in 25% (10 patients), microadenomas in 15% (6 patients), while pituitary hyperplasia and empty sella syndrome, each was detected in 10% (4 patients each ldiopathic hyperprolactinemia with normal MRI study were delected //: 32.5% (13 patients) .

In the remaining 7.5% (3 patients), hyperprolactinemia was due to infilterative sarcoidosis in one patient, parasellar meningioma in another and the last patient had infilterating nasopharyngeal carcinoma.

Cavernus sinuses invasion and optic chiasm compression were detected in 60% of patients presented with macroadenomas.

Pituitary' adenomas occur in patients of all ages and both sexes.

The frequency of microadenomas are much higher in women, perhaps due to late recognition in men.

Conclusion: MRI is the optimal imaging technique to evaluate the sellar/suprasellar regions.

Hyperprolactinemia secondary ٠ prolactinoma usually presents with a prolactin level, which is more than 3600mIU/L.

The key image in the work up of macroadenomas is the coronal plane which demonstrates the degree of suprasellar extension and size of the 'waist' as the tumor passes through the diaphragm sellae.

If the waist is ٠٠؛ narrow, then the usual transsphenoidal approach is replaced by a more invasive subfrontal craniotomy to remove the tumor.

It is also important ٠؛ look for cavernous sinus invasion as tumor located in the cavernous sinus can not be effectively removed by transsphenoid approach.

Results' from MR! must always be assessed in the light of the patients clinical history’ and biochemical parameters.