| Objective:1.To analyse the relevance between the results of the immunohistochemical staining with the six pituitary hormones(growth hormone,prolactin,adrenocorticotropic hormone,thyroid stimulating hormone,follicular stimulating hormone and luteinizing hormone) and the serum corresponding hormone levels and clinical symptoms.2.To analyse the data of the patients whose results of immunohistochemical stainin with the six pituitary hormones don't conform with the serum corresponding hormone levels and clinical symptoms.3.To evaluate the value of pathologic immunohistochemical staining method for the diagnosis with pituitary adenoma.Methods:1.All patients who were diagnosed with pituitary adenoma and had been operated in Huashan Hospital from 200642007 year were enrolled in this study.2.To enter the date of the patients enrolled inclueding sex,age,clinical symptoms and signs,both preoperative and postoperative serum hormone levels,the results of imaging and the pathologic diagonosis.3.To analyse the relevance between the results of the immunohistOchemica]staining of six pituitary hormones and the serum corresponding hormone levels and clinical symptoms respectively.4.To follow up the patients whose results of immunohistochemical stainin with the six pituitary hormonesdon't conform with the serum corresponding hormone levels and clinical symptoms, reconduct the immunohistochemical staining and explore the reasons for the inconsistency of diagnosis.Results:1.Growth hormone-secreting pituitary tumor①Among the patients whose immunohistochemical staining with GH are positive,there were 86.7%patients who match the clinical diagnostic criteria.On the other hand,among the patients who match the clinical diagnostic criteria,there were 85.2% patients whose immunohistochemical staining with GH were negative.The consistency of clinical diagnosis and pathologic diagnosis was 97.2%.②Among 18 patients who match the clinical diagnostic criteria but whose immunohistochemical staining with GH were negative,16 patients' s were diagnosed as non-functioning pituitary adenoma and 2 were prolactinoma by pathologic immunohistochemical staining method.All of these patients had the signs of acromegaly and the increased serum GH levels,and most of their postoperative serum GH levels decreased.②Among 16 patients who don't macth the clinical diagnostic criteria but whose immunohistochemical staining with GH were positive,there were 12 patients who had increased serum GH levels but no signs of acromegaly,3 patients who had signs of acromegaly but no increased serum GH levels,and l patient who had no signs of acromegaly and no increased serum GH level.2.Prolactinoma Regarding serum PRL＞150ng/ml as clinical diagnostic criteria①Among the patients whose immunohistochemical staining with PRL were positive,there were 70.9%patients who match the clinical diagnostic criteria.On the other hand,among the patients who match the clinical diagnostic criteria,there were 89.1% patients whose immunohistochemical staining with PRL were negative.The consistency of clinical diagnosis and pathologic diagnosis was 91.2%. ②Among 25 patients who match the clinical diagnostic criteria but whose immunohistochemical staining with PRL were negative,all of them had macroadenomas and 56.5%patients had compression symptoms.The ratio between serum PRL level and tumor diameter in above patients was significantly lower than those of the patients who match the clinical diagnostic criteria and whose immunohistochemical staining with PRL are positive(8.88 VS 19.18,P＜0.01).③Compare with the patients who had increased serum PRL but whose immunohistochemical staining with PRL were negative-called high PRL group,the patients who don' t match the clinical diagnostic criteria but whose immunohistochemical staining with PRL were positive had less proportion of macroadenomas and compression symptoms(P＜0.01).And the ratio between serum PRL level and tumor diameter was 9.7, Whereas the ratio of high PRL group was only 2.08(P＜0.01). Regarding serum PRL＞9Ong/ml as clinical diagnostic criteria①Among the patients whose immunohistochemical staining with PRL positive,there were 83.7%patients match the clinical diagnostic criteria.On the other hand,among the patients who match the clinical diagnostic criteria,there were 79.6%patients whose immunohistochemical staining with PRL were negative.The consistency of clinical diagnosis and pathologic diagnosis was 91.0%.②Among 62 patients who match the clinical diagnostic criteria but whose immunohistochemical staining with PRL are negative,all of them had macroadenomas and 59.7%patients had compression symptoms.The ratio between serum PRL level and tumor diameter in above patients was significantly lower than those of the patients who match the clinical diagnostic criteria and whose immunohistochemical staining with PRL are positive(7.48 VS 17.73,P＜0.01).②Compare with the patients who had increased serum PRL but whose immunohistochemical staining with PRL were negative-called high PRL group,the patients who don't match the clinical diagnostic criteria but whose immunohistochemical staining with PRL were positive had less proportion of macroadenomas and compression symptoms(P＜0.01).And the ratio between serum PRL level and tumor diameter was 4.9,whereas the ratio of increased PRL group was only 1.96(P＜0.01).Regarding pathologic diagnosis as gold standard and make ROC curve of serum PRL level,we can find out that when regard serum PRL＞100.06ng/ml as clinical diagnostic criteria,the crude agreement is hightest..3.Thyrotropin-secreting pituitary tumor①Among the patients whose immunohistochemical staining with TSH were positive,there were 21.6%patients whose serum TSH increased.On the other hand,among the patients whose serum TSH increased,there were 20.5%patients whose immunohistochemical staining with TSH were negative.②Among 31 patients whose serum TSH increase but immunohistochemical staining with TSH were negative,11 patients had hypothyroidism,1 patient had central hyperthyroidism and 19 patients's serum free triiodothyronine](FT3) and tetraiodothyronine(FT4) were within the normal range.③Among 29 patients whose serum TSH were within the normal range but immunohistochemical staining with TSH were positive,their serum free triiodothyronine](FT3) and tetraiodothyronine(FT4) were also within the normal range.4.Gonadotroph pituitary adenoma①Among the patients whose immunohistochemical staining with FSH/LH were positive,there were 20.9%patients whose serum FSH/LH increased.On the other hand,among the patients whose serum FSH/LH increased,there were 48.3%patients whose immunohistochemical staining with FSH/LH were negative.②Among 30 patients whose serum FSH/LH increased but immunohistochemical staining with FSH/LH were negative,26 patients were diagnosed as non-functioning pituitary adenoma,3 were growth hormone-secreting tumor and 1 was prolactinoma by pathologic immunohistochemical staining method.③There were no difference of age,sex,clinical symptoms and the proportion of macroadenoma between patients whose serum FSH/LH were within the normal range but immunohistochemical staining with FSH/LH were positive and the patients diagnosed with non-functioning pituitary adenoma(P＞0.05).Conclusion:1.Serum PRL＞100 ng/ml might be the cut-point of the diagnosis with prolactinoma.2.ALL postoperative pituitary tissue of patients diagnosed with pituitary adenoma should be examined by pathologic immunohistochemical staining method,particularly to those of the patients whose serum PRL level increased and whose six pituitary hormones in serum were within the normal range.To the patients whose serum PRL level increased,the exam of pathologic immunohistochemical staining method of GH,FSH,LH was important besides PRL.To the patients whose six pituitary hormones in serum were within the normal range,the exam of pathologic immunohistochemical staining method of FSH,LH was important.
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