Correlation between MRI findings of pituitary gland and prolactin level among hyperprolactinemia adult female Saudi patients in rural areas: A retrospective multicentric study

Identifying the prolactin threshold that necessitates pituitary magnetic resonance imaging (MRI) in patients with hyperprolactinemia remains challenging. Therefore, developing standards for serum prolactin level criteria to predict prolactinoma is critical. This study aimed to investigate the correlation between hyperprolactinemia and the presence of pituitary adenoma among Saudi female patients with verified prolactin levels. A retrospective multicentric study, including 4 regions from western Saudia Arabia between July 2020 and September 2023, included 168 female patients with abnormal prolactin levels who underwent brain MRI for the pituitary gland evaluation. The prevalence of pituitary adenoma and its associated factors and the relationship between blood prolactin levels and pituitary adenoma on brain MRI, as well as establishing the cutoff value of serum prolactin concentration linked to the existence of pituitary adenoma, were investigated and analyzed. The mean prolactin level was 72.7 ± 63.2 ng/mL. MRI findings were microadenoma in 77 (46.1%), macroadenoma in 17 (10.2%), Empty sella syndrome (ESS) in 7 (4.2%), and normal in 66 (39.5%) patients. In the ROC curve analysis, prolactin levels demonstrated a moderate degree of accuracy in predicting the existence of a pituitary adenoma (AUC = 0.640; 95% CI = 0.563-0.713; P = .0010], and the sensitivity and specificity were 40.59% and 83.33%, respectively. The ideal cutoff prolactin level for diagnosing pituitary adenoma was > 38.71 ng/mL with a sensitivity of 77.23% and specificity of 40.91%. It is prudent to perform pituitary imaging in most cases of hyperprolactinemia without event etiology, even if the condition is minor, due to the high prevalence of pituitary anomalies in female patients with hyperprolactinemia at serial sampling. A multidisciplinary strategy is necessary for a comprehensive diagnosis, treatment, and follow-up approach to improve the clinical outcomes of these individuals.