Hyperprolactinemia

How should these patients be treated?

Dopamine agonist: Bromocriptine or carbergoline. Cabergoline is more effective in reducing prolactin levels and prolactinoma size then bromocriptine and has fewer side effects. Must monitor prolactin levels to adjust medication dosages. Repeat MRI's are dependent on clinical situation. Treatment during pregnancy is limited to symptomatic patients and those with macro adenomas. Treatment resistance has been defined as failure to normalize prolactin level and decrease macroprolactin by > 50%, however higher dose carbergoline regimens may be effective. Transsphenoidal surgery may be required for symptomatic patients with prolactinomas who do not respond or can not tolerate high doses of cabergoline.

What is the evaluation consist of?

History of medications, pregnancy, headache, visual symptoms, hypothyroidism symptoms, and renal/liver disease. The physical examination should be directed for for signs of hypothyroidism, hypogonadism, visual field loss, and looking for chest wall abnormality.

Where is prolactin synthesized?

It is synthesized and secreted by the lactotroph cells in the pituitary glad, Elevated serum prolactin usually results from conditions that cause hyper secretion of prolactin by the lactotrophs

What is the difference between micro and macro adenoma?

Microadenoma Prolactinoma < 10mm and macroadenomas are > 10mm. Women with normal cycles and elevated prolactin may have pacroprolactinemia due to the large polymeric forms of prolactin and circulating anti-prolactin autoantibodies, Only about 10-20% have prolactinomas

What are some of the causes of hyper secretions of prolactin?

Physiologic causes: stress, nipple stimulation, sleep, exercise, coitus, pregnancy, and lactation. Pathologic causes: Hypothalamus-pituitary stalk damage: trauma, radiation, rathe's cyst, infiltrative diseases and parasellar tumors, Pituitary disorders such as prolactinomas, acromegaly, and macroprolactinomas, Systemic disorders such as primary hypothyroidism, chest wall injury due to trauma, surgery, herpes zoster, chronic renal and lung cancer, Pharmacologic causes dues to some anti-psychotic, gastric motility drugs, antihypertensives, dopamine receptor blockers, opiates, and H2 antihistamines, and idiopathic

What are the clinical manifestations of hyperprolactinemai?

Premenopausal: Oligomenorrhea, primary or secondary amenorrhea, anovulatory infertility, galactorrhea, headaches, or vision changes in its with macroprolactinomas. Level > 20-25ng/ml is considered abnormally high. In patients with suspected drug induced hyperprolactinemia, medication can be discontinued for 3 days and then repeat the prolactin

What laboratory tests should include?

Prolactin and MRI. An MRI of the sella turcica is required to diagnose a micro/macroadenoma or a mass lesion in the hypothalamic-pituitary region. Idiopathic hyperprolactinemia is diagnosed in the the absence of pituitary and central lesion on MRI ad the absence of secondary causes.