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DIAGNOSTICO DIFERENCIAL DE LOS PROLACTINOMAS

(especial para SIIC © Derechos reservados)
Distinguir los prolactinomas de los seudoprolactinomas es esencial debido que la terapia para cada uno de ellos es completamente diferente: médica para los primeros, quirúrgica en los últimos.
Autor:
Marco Losa
Columnista Experto de SIIC

Institución:
Università Vita-Salute

Artículos publicados por Marco Losa
Coautor
Paolo Ribotto* 
MD, Università Vita-Salute, Milán, Italia*
Recepción del artículo
2 de Noviembre, 2007 		Aprobación
23 de Enero, 2008
Primera edición
25 de Marzo, 2009 		Segunda edición, ampliada y corregida
7 de Junio, 2021

DIAGNOSTICO DIFERENCIAL DE LOS PROLACTINOMAS

Resumen
La hiperprolactinemia puede deberse tanto a adenomas hipofisarios que secretan prolactina (prolactinomas) como a tumores selares no funcionantes (denominados "seudoprolactinomas"). La relación entre el tamaño del tumor y el grado de prolactinemia habitualmente permite distinguir los prolactinomas de los seudoprolactinomas; este diagnóstico diferencial es esencial, dado que la terapia es completamente diferente (médica en el primer caso, quirúrgica en el último). La posible coexistencia de otras causas fisiológicas, patológicas o yatrogénicas de hiperprolactinemia, así como artefactos de laboratorio ("efecto gancho") y la presencia de variantes de prolactina desprovistas de actividad biológica (macroprolactinas) puede dar origen a errores. Los médicos deben conocer estos trastornos, dado que cuando no se reconocen se pueden realizar tratamientos inapropiados.

Palabras clave
neoplasia hipofisaria, prolactina, adenomas hipofisarios no funcionantes, cirugía de hipófisis


Artículo completo
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Extensión:  +/-7.53 páginas impresas en papel A4
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Pitfalls in Distinguishing True Prolactinomas from "Pseudoprolactinomas"

Abstract
Hyperprolactinemia can be due to both prolactin-secreting pituitary adenomas (prolactinomas) and nonfunctioning sellar tumors (so called "pseudoprolactinomas"). The ratio between the size of the lesion and the degree of hyperprolactinemia usually permits to distinguish prolactinomas from pseudoprolactinomas; this differential diagnosis is essential, since therapy is entirely different (medical in the former case, surgical in the latter). The possible coexistence of other physiologic, pathologic or iatrogenic cause of hyperprolactinemia, as well as laboratory artifacts ("hook effect") and the presence of prolactin variants devoid of biological activity (macroprolactins) can give origin to pitfalls. Clinicians should be aware of these conditions, since inappropriate treatments can result if they are not recognized.

Key words
pituitary neoplasm, prolactin, nonfunctioning pituitary adenomas, pituitary surgery


Full text
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Clasificación en siicsalud
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Especialidades
Principal: Neurocirugía
Relacionadas: Atención Primaria, Bioquímica, Diagnóstico por Imágenes, Diagnóstico por Laboratorio, Endocrinología y Metabolismo, Farmacología, Medicina Interna



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Enviar correspondencia a:
Marco Losa, Istituto Scientifico San Raffaele Dept. of Neurosurgery, 20132, Via Olgettina 60, Milán, Italia
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