PRL was measured radioimmunologically in plasma and cerebrospinal fluid (CSF) samples obtained simultaneously in 31 patients with various neurological or infectious, but non-endocrine diseases (group A), 12 patients (7 pregnant women and 5 newborns) with physiological hyperprolactinemia (group B),10 psychiatric patients with pharmacologically induced hyperprolactinemia (group C) 12 normoprolactinemic patients with pituitary adenoma and suprasellar extension (SSE) (group D), And 14 hyperprolactinemic patients with pituitary adenoma with and without SSE (group E). Plasma PRL and CSF PRL concentrations (ng/ml, mean and range in brackets) of the various groups were: group A, 6.2 (1.3-14.5) and 1.3 (0.6-4.7); group B, 85.2 (31-200) and 13.2 (3-28); group C, 54.3 (3.5-160) and 6.5 (0.7-18); group D, 17.2 (5.4-30) and 9.7 (2.7-34); and group E, 2,529 (115-10,000) and 1,449 (6-13,000). The plasma to CSF concentration ratios (mean and range in brackets) were: group A, 5.2 (1.4-13.0); group B, 7.0 (2.9-10.3); group C, 7.3( 3.9-11.3); group D, 2.6 (0.9-7.1); and group E, 10.9 (0.2-34.9). The ratio was greater than 3 in 87% of the non-tumor patients; in 42% of the tumor patients the ratio was less than 3. The correlation between plasma and CSF PRL levels of all 53 subjects without a pituitary tumor (groups A, B, and C) was positive (r=0.9097; P=0.00001); in the 26 tumor patients (groups D and E) the correlation was also positive (r=0.7141; P=0.00002). These results indicate that 1) PRL is a normal constituent of CSF, 2) the CSF PRL level is a function of the plasma level, 3) detectable, or even high, CSF PRL levels per se are not indicative in the presence of a pituitary tumor, with or without SSE, and 4) abnormally low ratios may be found in patients with a pituitary tumor with SSE.
Plasma and cerebrospinal fluid (CSF) levels of two hormones of similar molecular size, pituitary prolactin (PRL) and human chorionic somatomammotropin (hCS), and of the bigger hormone human chorionic gonadotropin (hCG) were measured in six pregnant women without pituitary disease. For all three hormones, the plasma and CSF levels were closely correlated. The plasma/CSF concentration ratio for hCG (571 +/- 378, mean +/- SD) was significantly different (P less than 0.01) from the hCS ratio (24.6 +/- 6.1); the hCS ratio was significantly different (P less than 0.005) from the PRL ratio (7.2 +/- 1.5). We conclude that (1) the CSF concentration of a protein hormone depends on the plasma concentration and on its molecular size, and (2) pituitary hormones reach the CSF not only via filtration of peripheral blood at the choroid plexuses, but also more directly via retrograde transport from the pituitary to the brain.
The plasma Prl response to 200 \ g=m\ g TRH iv was evaluated in 6 hyperprolactinaemic women without radiological evidence of a pituitary tumour (group I), in 15 hyperprolactinaemic women with dubious (group II) and in 17 normo-or hyperprolactinaemic women with clear (group III) radiological abnormalities, in 18 normoor hyperprolactinaemic men with clear radiological abnormalities (group IV), and in 4 women and 3 men with hyperprolactinaemia and sellar destruction who had been treated in the past for pituitary adenoma (group V). The responses were compared with those obtained in a control group of 83 (42 women, 41 men) normoprolactinaemic healthy individuals. The Prl response was defined as a ratio (R2): the 20 min value minus the 0 min value, divided by the 0 min value.The median R2 values were: female controls 5.1, male controls 3.1, group I 0.1, group II 0.2, group III 0.3, group IV 0.55, group V females 0.45 and males 0.It is concluded that 1) subjects suspected of harbouring a microprolactinoma (groups I and II) demonstrate absent or attenuated responses similar to those found in patients with definite prolactinomas and 2) a value of plasma Prl 20 min after 200 \ g=m\ g TRH iv greater than 3.5 times the basal level (R2 > 2.5) rules out the presence of a prolactinoma.
The hormonal responses to anaesthesia and cardiac surgery were studied in 20 patients. Ten patients were anaesthetized with fentanyl 60 microgram kg-1 and nitrous oxide in oxygen and 10 with etomidate 0.3 mgkg-1 and nitrous oxide in oxygen plus halothane. There were no significant changes in cortisol, growth hormone or insulin concentrations in response to surgery in either group, although cortisol concentrations decreased during cardiopulmonary bypass. Both groups showed increases in prolactin concentrations. Patients anaesthetized with etomidate and halothane showed a significant increase in adrenaline and glucose concentrations not seen in the fentanyl group. Cardiopulmonary bypass was associated with marked increases in catecholamines in both groups.
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