MRI of the Pituitary Gland in the Follow-Up of Surgical and Conservative Therapy of Hyperprolactinaemic Syndrome

Aim. Persitent galactorrhoea-amenorrhoea syndrome is closely dependent on hypothalamic-pituitary disorders, thyroid disorders and possible presence of pituitary adenoma, often use to be a reason for sterility. In patients with arterial hypertension the hyperprolactinaemia can serve as ethiologic component of arterial hypertension. Thus we retrospectively evaluated the relationship of MRI features and clinical presentations in galactorrhoea-amenorrhoea syndrome. Material and methods. The study comprised 1230 persons, separated to two groups. Retrospectively the results of diagnostic MRI studies of hypophysis were analyzed in patients with hyperprolactinaemia (the study group - 1200 (97,6%) patients, 84 (7%) male and 1116 (93%) female. The duration of the follow-up did last for up to 17 years. At cardiovascular examination in 30% of these also the arterial hypertension of studies 2-3 was revealed. The control group included 30 (2.4%) healthy persons, in whom the magnetic resonance tomographic study of the brain was carried out from traumatologic or psychiatric indications and did not revealed any abnormal results. Results. From the results of the MRI studies the patients were assigned to one of the following four groups: the first (n = 869 (72.4%) comprised patients with pituitary adenopathy when crossover dimension of T1-hypointensive inclusions to the pituitary was n below 3 mm; the second (n = 202 (16.9%) included cases of microadenomas as little as four to six mm; the third (n = 59 (4.9%) included cases of pituitary microadenomas in ranges 6 to 10 mm; the fourth (n = 70 (5.8%) comprised macroadenomas of hypophysis with dimension over 11 mm. Recurrent adenomas after surgical treatment were in 13 (19.7%) cases of the group 4. There are presented cases of successful therapeutic treatment of prolactinomas with dimensions bigger than 20 mm. In adenopathies the sufficient periodic factor is one MRI scanning per two years, in adenomas as little as 4-6 mm it is once per 1,5 years; in prolactinomas as large as 6-10 mm and bigger once per year. Conclusion. From the results of long-term follow-up of patients there are, first, an approach supposed to the classification of adenomas (prolactinomas) of the hypophysis basing on anatomic dimensions measured by MR-tomography, and second, an optimal repetition factor has been formulated for repeat MRI studies in patients after surgical and medical therapy of prolactinomas.

аденомы гипофиза, дифференциальный диагноз, динамическое МРТ-наблюдение, гиперпролактинемия, пролактиномы, рецидивы аденом, adenomas of the hypophysis differential diagnosis, dynamic MRI follow-up, hyperprolactinaemia, prolactinomas, recurrencies of adenomas

1. Riedel M., Noldus J., Saeger W., Ludecke D.K. Sellar lesions associated with isolated hyperprolactinaemia. Morphological, immunocytochemical, hormonal and clinical results. Acta Endocrinol. 1986; 113 (2): 196-203.

2. Эндокринология: Руководство для врачей. В 2 томах. Т. 1; Под ред. С.Б. Шустова. СПб.: СпецЛит, 2011. 67-73.

3. Мычка В.Б., Чазова И.Е. Роль гипоталамо-гипофизарно-надпочечниковой оси в патогенезе артериальной гипертонии у больных с пролактиномой передней доли гипофиза. Тер. арх. 2000; 72 (9): 10-13.

4. Sage M.R., Blumbergs P.C. Primary empty sella turcica: A radiological-anatomical correlation. Australasian Radiol. 2000; 44: 341-348.

5. Дедов И.И., Терновой С.К., Воронцов А.В. Клиническое применение магнитно-резонансной томографии в диагностике аденом гипофиза. М.: Медицина, 2003. 47-56.

6. Беличенко О.И., Воронцов А.В. Основы магнитно-резонансной томографии и применение МРТ в клинической практике. Терапевт. 2010; 7: 49-56.

7. Di Chiro G., Nelson K.B. The volume of the sella turcica. Am. J. Radiol. 1962; 87: 989-1008.

8. Лукьянёнок П.И., Дубровин А.В., Гудкова Т.К., Бородин О.Ю. Определение объема гипофиза по данным сагиттальных сечений при низкопольной магнитнорезонансной томографии. Мед. виз. 2007; 3: 29-36.

9. Lukyanyonok P.I., Doubrovin A.V., Kollogrivova I.V. Determination of hypophysis volume by sagittal slices date obtained by low field magnetic resonance tomography. Int. J. Appl. Fundamental Res. 2011; 1: 11-17.

10. Lundin P., Pedersen F. Volume of pituitary macroadenomas: assessment by MRI. J. Comput. Assist. Tomogr. 1992; 16: 518-528.

11. Белов С.А., Ахадов Т.А., Кравцов А.К. Магнитно-резонансная томография гипофиза у детей в норме, при гипофизарном нанизме и других патологических состояниях. Современные возможности магнитно-резонансной томографии. М., 12-13 ноября, 1998; 29-33.

12. Шалек Р.А., Виноградов В.М., Гармашов Ю.А. и др. Стереотаксическая протонная радиохирургия и фотонная терапия артериовенозных мальформаций. Радиология - практика. 2008, 4: 13-18.

13. Алешин Б.В. Гистофизиология гипоталамо-гипофизарной системы. М.: Медицина, 1971. 440 с.

14. Rudnik A., Kos-Kudla B., Larysz D. et al. Endoscopic transsphenoidal treatment of hormonally active pituitary adenomas. Neuro Endocrinol. Lett. 2007; 8 (4): 438-444.

15. Wu Z.B., Su Z.P., Wu J.S. et al. Five years follow-up of invasive prolactinomas with special reference to the control of cavernous sinus invasion. Pituitary. 2008; 11 (1): 63-70.

16. Vale F.L., Deukmedjian A.R., Hann S. et al. Medically treated prolactin-secreting pituitary adenomas: when should we operate? Br. J. Neurosurg. 2013; 27(1): 56-62.

17. Maiter D., Primeau V. 2012 update in the treatment of prolactinomas. Ann. Endocrinol. (Paris). 2012; 73 (2): 90-98.

18. Yang M.S., Hong J.W., Lee S.K. et al. Clinical management and outcome of 36 invasive prolactinomas treated with dopamine agonist. J. Neurooncol. 2011; 104 (1): 195-204.