Morbus Cushing und Prolaktinom

Zusammenfassung

Vorgestellt werden eine Auswahl der im Jahr 2005 erschienenen Publikationen zum Morbus Cushing und zum Prolaktinom sowie eine Kasuistik zur Diagnose und Differenzialdiagnose des Prolaktinoms. Einige wichtige Botschaften: Die nächtliche Speichelcortisol-Bestimmung könnte zum neuen Goldstandard in der Diagnostik des Morbus Cushing avancieren. Bei Patienten mit Hypercortisolismus ist ein postoperatives Serumkortisol < 2 mg/dl bzw. ein normaler Dexamethson-Hemmtest kein Kriterium, das Rezidivfreiheit garantiert. Die Diagnostik eines Hypercortisolismus in der Schwangerschaft geschieht nach besonderen Regeln. Die Makroprolaktinämie ist ein Laborproblem mit geringer klinischer Relevanz. In der klinischen Routine sollte bei jedem Makroadenom eine Prolaktin-Verdünnungsreihe durchgeführt werden.

Summary

A selection of publication on Cushing's disease and prolactinoma during 2005 are reviewed and a case report on the diagnosis and differential diagnosis of prolactinoma is presented. There are some important lessons: the measurement of nocturnal salivary cortisol may become the new gold standard for the diagnosis of Cushing's syndrome. In patientswith Cushing's disease a postoperative serum cortisol of < 2 g/dl or a normal dexamethasone inhibition test is no criterion of remission that guarantees freedom from recurrence. Diagnostic criteria for hypercortisolism during pregnancy must follow special rules. Macroprolactinemia is a laboratory problem that has little clinical relevance. A prolactin dilution series should be done in every case of macroadenoma.

Literatur

• 1 Atkinson A B, Kennedy A, Wiggam M I, McCance D R, Sheridan B. Long-term remission rates after pituitary surgery for Cushing’s disease: the need for long-term surveillance.  Clin Endocrinol (Oxf). 2005;  63 549-559
• 2 Batista D, Courkoutsakis N A, Oldfield E H. et al . Detection of adrenocorticotropin-secreting pituitary adenomas by magnetic resonance imaging in children and adolescents with cushing disease.  J Clin Endocrinol Metab. 2005;  90 5134-5140
• 3 Batista D, Gennari M, Riar J. et al . An assessment of petrosal sinus sampling for localization of pituitary microadenomas in children with Cushing disease.  J Clin Endocrinol Metab. 2005;  91 221-224
• 4 Biswas M, Smith J, Jadon D. et al . Long-term remission following withdrawal of dopamine agonist therapy in subjects with microprolactinomas.  Clin Endocrinol (Oxf). 2005;  63 26-31
• 5 Davies J H, Storr H L, Davies K. et al . Final adult height and body mass index after cure of paediatric Cushing’s disease.  Clin Endocrinol (Oxf). 2005;  62 466-472
• 6 Faggiano A, Melis D, Alfieri R. et al . Sulfur amino acids in Cushing’s disease: insight in homocysteine and taurine levels in patients with active and cured disease.  J Clin Endocrinol Metab. 2005;  90 6616-6622
• 7 Gibney J, Smith T P, McKenna T J. The impact on clinical practice of routine screening for macroprolactin.  J Clin Endocrinol Metab. 2005;  90 3927-3932
• 8 Gibney J, Smith T P, McKenna T J. Clinical relevance of macroprolactin.  Clin Endocrinol (Oxf). 2005b;  62 633-643
• 9 Glezer A, Soares C R, Vieira J G. et al . Human Macroprolactin Displays Low Biological Activity via its Homologous Receptor in a New Sensitive Bioassay.  J Clin Endocrinol Metab. 2006;  91 1048-1055
• 10 Ilias I, Torpy D J, Pacak K, Mullen N, Wesley R A, Nieman L K. Cushing’s syndrome due to ectopic corticotropin secretion: twenty years’ experience at the National Institutes of Health.  J Clin Endocrinol Metab. 2005;  90 4955-4962
• 11 Lindsay J R, Jonklaas J, Oldfield E H, Nieman L K. Cushing’s syndrome during pregnancy: personal experience and review of the literature.  J Clin Endocrinol Metab. 2005;  90 3077-3083
• 12 Locatelli M, Vance M L, Laws E R. Clinical review: the strategy of immediate reoperation for transsphenoidal surgery for Cushing’s disease.  J Clin Endocrinol Metab. 2005;  90 5478-5482
• 13 Trilck M, Flitsch J, Ludecke D K, Jung R, Petersenn S. Salivary cortisol measurement - a reliable method for the diagnosis of Cushing’s syndrome.  Exp Clin Endocrinol Diabetes. 2005;  113 225-230
• 14 Viardot A, Huber P, Puder J J, Zulewski H, Keller U, Muller B. Reproducibility of nighttime salivary cortisol and its use in the diagnosis of hypercortisolism compared with urinary free cortisol and overnight dexamethasone suppression test.  J Clin Endocrinol Metab. 2005;  90 5730-5736