| Objective:1. To analyze the correlation between 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 analyze the reason of the patients whose immunohistochemical stainin unconformed with the corresponding serum hormone levels and clinical symptoms. 3. To examine the value of preoperative hormone levels assay in the diagnosis of patients with pituitary adenoma. 4. 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 2006-2009 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 correlation between the results of the immunohistochemical staining of six pituitary hormones and the serum corresponding hormone levels and clinical symptoms respectively.4. To follow up the patients whose immunohistochemical stainin unconformed with the corresponding serum 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 were positive, there were 74.3% patients who match the clinical diagnostic criteria. On the other hand, among the patients who match the clinical diagnostic criteria, there were 76.7% patients whose immunohistochemical staining with GH were negative. The consistency of clinical diagnosis and pathologic diagnosis was 94.3%.②Among 52 patients who match the clinical diagnostic criteria but whose immunohistochemical staining with GH were negative,43 patients’s were diagnosed as non-functioning pituitary adenoma and 9 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 59 patients who don’t macth the clinical diagnostic criteria but whose immunohistochemical staining with GH were positive, there were 40 patients who had increased serum GH levels but no signs of acromegaly,9 patients who had signs of acromegaly but no increased serum GH levels, and 10 patient who had no signs of acromegaly and no increased serum GH level.2. ProlactinomaRegarding serum PRL>150ng/ml as clinical diagnostic criteria①Among the patients whose immunohistochemical staining with PRL were positive, there were 66.6% patients who match the clinical diagnostic criteria. On the other hand, among the patients who match the clinical diagnostic criteria, there were 91.1% patients whose immunohistochemical staining with PRL were negative. The consistency of clinical diagnosis and pathologic diagnosis was 89.1%.②Among 34 patients who match the clinical diagnostic criteria but whose immunohistochemical staining with PRL were negative,all of them had macroadenomas and 55.9% 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 were positive (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 7.6, whereas the ratio of high PRL group was only 2.4 (P<0.01) Regarding serum PRL>90ng/ml as clinical diagnostic criteria①Among the patients whose immunohistochemical staining with PRL were positive, there were 78.6% patients match the clinical diagnostic criteria. On the other hand, among the patients who match the clinical diagnostic criteria, there were 82.7% patients whose immunohistochemical staining with PRL were negative. The consistency of clinical diagnosis and pathologic diagnosis was 89.7%.②Among 86 patients who match the clinical diagnostic criteria but whose immunohistochemical staining with PRL were negative, all of them had macroadenomas and 61.6% 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 were positive (7.2 VS 19.9, 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 6.2, whereas the ratio of increased PRL group was only 2.2(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>110.70ng/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 10.5% patients whose serum TSH increased. On the other hand, among the patients whose serum TSH increased, there were 10.1% patients whose immunohistochemical staining with TSH were negative.②Among 71 patients whose serum TSH increase but immunohistochemical staining with TSH were negative,18 patients had hypothyroidism,4 patient had central hyperthyroidism and 49 patients’s serum free triiodothyronine](FT3) and tetraiodothyronine(FT4) were within the normal range.③Among 68 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 were positive, there were 29.6% patients whose serum FSH increased. On the other hand, among the patients whose serum FSH increased, there were 54% patients whose immunohistochemical staining with FSH/LH were negative.②Among 52 patients whose serum FSH increased but immunohistochemical staining with FSH were negative,42 patients were diagnosed as non-functioning pituitary adenoma,8 were growth hormone-secreting tumor and 2 was prolactinoma by pathologic immunohistochemical staining method.③In male patients, the higher the preoperative serum FSH level, the greater FSH tumor possibility. According to the ROC curve, when FSH take 11.2 as the standard, the specificity was 90%, sensitivity 36.3%; when FSH level take 15.1 as the standard, the specificity was 95%, sensitivity of 29.5%.④In female patients, due to FSH vary greatly in different menstrual cycle, in postmenopausal women, preoperative FSH level in FSH tumor patients which established by immunohistochemistry within normal range; while women in non-menopausal, preoperative FSH level in FSH tumor patients which established by immunohistochemistry also did not exceed the upper limit.Conclusion:1. Serum GH levels assay have a good specificity for the diagnosis of GH tumors, it was instructive that preoperative serum GH levels measure for the clinical diagnosis of GH tumors.2. In patients with pituitary tumors, serum PRL levels in diagnosis of prolactinomas take 110ng/ml as cutting point, there were the highest consistency rate with immunohistochemical staining pathological diagnosis.3. 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 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 was important. 4. For patients with pituitary TSH tumors, serum TSH levels were less specific for the diagnosis of tumors, preoperative serum TSH levels in patients with pituitary TSH tumors was no clinical significance, the clinical diagnosis to be confirmed after pathological.5. For patients with pituitary FSH tumors, serum FSH levels measured for the diagnosis of FSH tumors was less sensitive, male patients with preoperative serum FSH levels significantly increased FSH on the clinical diagnosis of tumors had some significance, while female patients were not. |
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