Hyperprolactinemia

From Anvita Health Wiki

Contents 1 Etiology 2 Pathology 3 Clinical-manifestations 4 Laboratory 5 Management 6 More General Terms 7 Additional Terms 8 References

Etiology

• prolactin- secreting adenoma
• pituitary stalk effects:

• non functioning pituitary tumors
• growth hormone secreting tumors
• lymphocytic hypophysitis
• empty sella syndrome
• Cushing's disease

• extra- pituitary lesions

• craniopharyngioma
• hypothalamic disease

• sarcoidosis
• Langerhans cell histiocytosis
• lymphoma

• metastatic tumors to pituitary or hypothalamus
• meningioma
• dysgerminomas
• irradiation

• neurogenic

• chest wall or spinal cord disease
• breast stimulation
• breast lesions

• pharmacologic agents

• phenothiazines
• thioxanthenes
• other dopaminergic antagonists
• tricyclic antidepressants
• verapamil
• methyldopa
• antiretroviral protease inhibitors [3]
• estrogen in usual doses does NOT cause hyperprolactinemia

• other

• hypothyroidism [3]
• pregnancy
• chronic renal failure (decreased prolactin clearance)
• cirrhosis
• macroprolactinemia (decreased prolactin clearance)
• adrenal insufficiency
• ectopic secretion
• idiopathic

Pathology

• disruption of dopaminergic tuberoinfundibular system inhibition on prolactin secretion by pituitary lactotrophs

Clinical-manifestations

• galactorrhea in 1/3 of patients

Laboratory

• serum prolactin

• normal 0-23 ng/mL
• value > 200 ng/mL confirms prolactinoma as etiology
• value < 200 ng/mL when due to hypothyroidism [3]

Management

• dopaminergic agonists

• bromocryptine ( Parlodel) 2.5 mg PO QD

• inhibits prolactin secretion
• reduces serum prolactin level
• controls & shrinks prolactinoma

• cabergoline [3]

• patient education: fertility in women can be achieved through use of bromocryptine

More General Terms

• endocrine disease
• syndrome

Additional Terms

• pituitary adenoma/prolactin secreting (prolactinoma)
• prolactin; lactogenic hormone (PRL)

References

1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 389
2. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 276
3. Medical Knowledge Self Assessment Program (MKSAP) 14, 15 American College of Physicians, Philadelphia 2006, 2009
4. National Guideline Clearinghouse Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline. ngc-guideline: [1]

hyperprolactinemia