Cerebrospinal fluid (CSF)/serum albumin ratio shows no alteration of the blood-brain barrier in patients with pituitary adenomas and high CSF levels of pituitary hormones

Monica Livia Gheorghiu; Mariana Purice; Catrinel Rusu; Simona Galoiu; Ruxandra Tanasescu; Dan Niculescu; Mihai Coculescu

P566

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Endocrine Abstracts (2007) 14 P566

ECE2007 Poster Presentations (1) (659 abstracts)

Cerebrospinal fluid (CSF)/serum albumin ratio shows no alteration of the blood-brain barrier in patients with pituitary adenomas and high CSF levels of pituitary hormones

Monica Livia Gheorghiu ¹ , Mariana Purice ² , Catrinel Rusu ³ , Simona Galoiu ¹ , Ruxandra Tanasescu ¹ , Dan Niculescu ¹ & Mihai Coculescu ¹

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¹‘C. Davila’ University of Medicine & Pharmacy, Bucharest, Romania; ²‘C.I.Parhon’ Institute of Endocrinology, Bucharest, Romania; &br;³‘N. Kretzulescu’ Medical Center of the Internal Affairs Ministry, Bucharest, Romania.

Some patients with pituitary adenomas show high CSF levels and/or high CSF/serum ratio for peptidic pituitary hormones (PR), potentially due to a blood-brain barrier (BBB) damage. We evaluated albumin.CSF/serum ratio (AR) in patients with pituitary adenomas and elevated PR, as an accurate index for a BBB damage.

Patients and methods: We evaluated 10 controls (21–79 years, 6M /4 F) before undergoing abdominal or peripheral surgery and 52 patients with pituitary adenomas (PA) (17–79 years, 25 M/27F, 16 before and 36 after pituitary surgery), with the approval of the local Ethical Committee. Anterior pituitary hormones and albumin were measured in simultaneously sampled serum and CSF by rapid fluoroimmunoassay and nephelometry, respectively. AR >0.007 was considered abnormal.

Results: In PA, median albumin in serum (4625±1134 mg/dl) and CSF (24.7±37.7 mg/dl) was not statistically different from controls (3710+710 mg/dl and 20.2±8.2 mg/dl, respectively). In 1/7 (14%) controls and 9/52 (17%) PA, AR was >0.007 (NS).

PR >1 for at least one pituitary hormone was found in significantly more patients with tumors in contact with BBB (suprasellar extension + neuroophtalmic syndrome or intracavernous sinus invasion), either before pituitary surgery (10/21=47%) or after surgery (9/16=56%), compared with only 1/15 (6%) in PA without contact with BBB before surgery (P=0.001). Albumin CSF, serum and R were not statistically different between contact and non-contact tumors or in patients with PR>1 compared to those with PR<1.

Conclusion: CSF/serum albumin evaluation shows that there is no alteration of the CSF flow rate in patients with pituitary adenomas and increased CSF/serum ratio for the anterior pituitary hormones, compared to controls. It is tempting to believe that the increased hormonal level in CSF is due to the tumor secretion.