Hyperprolactinaemia
- Secondary hypogonadism
- Infertility
- Osteoporosis
- Excess production from the pituitary (prolactinoma)
- Disinhibition by compression of the pituitary stalk reducing dopamine levels
- Administration of a dopamine antagonist
- Pregnancy, breast feeding, stress (post seizure)
- Phenothiazines, metachlopromide, haloperidol, ?-methyldopa, oestrogens
- Prolactinoma – micro or macroadenoma
- Stalk damage – pituitary adenomas, trauma, surgery
- Hypothalamic disease – crangiopharyngiomas, other tumours
- Other causes – hypothyroidism (due to increased TRH), chronic renal failure (reduced excretion)
Symptoms
- Amenorrheoa/oligomenorrhoea, infertility, galactorrhoea
- Reduced libido, increased weight
- In men impotence, reduced facial hair
- May also present late with osteoarthritis or local pressure effect from the tumour
Tests
- Basal PRL – non-stressful venopuncture between
9am and4pm - Do a pregnancy test
- TFT, U&Es
- MRI pituitary
Management
- Dopamine agonists – bromocryptine or cabergoline
- Microprolactinomas;
- A tumour <10mm on MRI
- Treat with dopamine agonist
- Bromocriptine is generally used first line although it has more side effects e.g. nausea, depression , postural hypotension but is safer in pregnancy
- If patient is not tolerant of the medication then transphenoidal surgery is indicated. The risks are tumour reoccurrence and permanent hormone deficiency
- A tumour <10mm on MRI
- Macroadenoma
- Shrink first with a dopamine agonist. Surgery is usually indicated if there are visual symptoms or pressure effects or if pregnancy is planed as 25% of macroadenomas expand during pregnancy
- Bromocriptine and in some cases radiotherapy can be given post op as surgical resection is commonly incomplete