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  Hyperprolactinoma
 
Author: Gary Wand, M.D. Last modified: December 6, 2001
DIAGNOSTIC CRITERIA

  EPIDEMIOLOGY

  • Most common pituitary disorder
  • Effects women more frequently than men
  • Hyperproactinemia is found in approximately 18% of women with amenorrhea, 25% of women with galactorrhea, 30% of infertile women and 70% of women with amenorrhea and galactorrhea.

  RISK FACTORS

  • Multiple Endocrine Neoplasia Syndrome Type I
  • Certain medications (e.g., dopamine antagonists)
  • Primary hypothyroidism
  • Chest wall injury

  SIGNS AND SYMPTOMS

  • Galactorrhea
  • Oligo- or amenorrhea
  • Infertility
  • Hot Flushes
  • Vaginal Dryness
  • Pain on sexual intercourse
  • Reduced sex drive
  • Erectile dysfunction
  • Gynecomastia
  • Oligospermia
  • Osteoporosis
  • Hirsutism
  • Possible headache, visual problems and hormone deficits if associated with pituitary tumor

  DIFFERENTIAL DIAGNOSIS

  • Prolactin secreting pituitary adenoma
  • Growth hormone secreting pituitary adenoma
  • Nonfunctioning pituitary macroadenoma
  • Parasella lesions e.g., craniopharyngioma
  • Hypothalamic tumors
  • Hypothalamic infiltrative diseases e.g., neurosarcoidosis
  • Primary hypothyroidism
  • Polycystic ovarian disease
  • Renal failure
  • Liver failure
  • Medications e.g., dopamine antagonists
  • Chest wall trauma
  • Pregnancy
  • Postprandial elevation
  • Nipple stimulation
  • Coitus
  • Seizure

  LABORATORY FINDINGS

  • Elevated prolactin
  • Low LH and FSH
  • Low estrogen or testosterone
 
TREATMENT
CABERGOLINE
  • 0.25-0.5 mg once or twice per week
  • Long duration of action
  • Side effects less common than other formulations
  • Recommend taking at bedtime with small amount of food
BROMOCRIPTINE
  • 2.5-7.5 mg per day in divided doses
  • Side effects are more common
  • Take with meals
SURGERY
  • When macroproactinoma is the cause of hyperprolactinemia and is resistant to medical therapy
  • When patient cannot tolerate medical therapy in the setting of a macroprolactinoma or growing microadenoma.
 
IMPORTANT POINTS/RECOMMENDATIONS
  • Before considering a pituitary cause of hyperprolactinemia, rule out primary hypothyroidism, pregnancy and medications that stimulate prolactin.
  • Review the pros and cons of continuing medical therapy for the treatment of a prolactinoma during pregnancy.
 
REFERENCES
  1. Molitch ME ;  Medical treatment of prolactinomas ;  Endocrinol Metab Clin North Am 28:143-69, 1999.

  2. Randeva HS, Davis M, Prelevic GM ;  Prolactinoma and pregnancy ;  British Journal Obstetrics and Gynecology 107:1064-1068,2000.

Copyright © 2002 The Johns Hopkins University School of Medicine. All rights reserved.