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.
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Priv.-Doz. Dr. Dr. med. Dagmar Führer
Medizinische Klinik III, Universitätsklinikum Leipzig AöR
Philipp-Rosenthal-Straße 27
04103 Leipzig
Telefon: 0341-97-13301
eMail: fued@medizin.uni-leipzig.de
