Hyperprolactinemia

Physiology learnobgyn.com

 Hyperprolactinemia: Elevated levels of PRL (>20 ng/mL)  Physiologic vs pathologic causes Definitions learnobgyn.com

 Pregnancy : ↑ estrogen → lactotroph hyperplasia  Nipple stimulation : ↓ response w/ ↑ time since delivery  Stress : causes mild increase (<40 ng/mL) Physiologic Causes learnobgyn.com

 Drugs : antipsychotics, TCA’s, antiemetic’s, opioids, OCP’s, metyldopa  Hypothalamic-pituitary conditions : prolactinoma / other adenomas, craniopharyngioma, sarcoidosis, surgery / trauma, metastatic cancer  Hypothyroidism : ↓ T4 → TRH → ↑ PRL  Renal failure : PRL is cleared by kidneys  Chest wall trauma (eg surgery, burns, implants, herpes zoster) Pathologic Causes learnobgyn.com

 Microprolactinoma ( 1cm)  95% of microprolactinomas do not enlarge  75% of pituitary adenomas in females  50% of women w/ hyperprolactinoma have a prolactinoma  Nearly 100% if PRL > 200 ng/mL Prolactinoma: Background learnobgyn.com

 Oligo / amenorrhea  Hypogonadism  ↓ Bone density  Galactorrhea  Headache / nausea / vomiting  Bitemporal hemianopsia Clinical Presentation learnobgyn.com

 H&P: pregnancy, drugs, hypothyroidism, renal disease, visual changes, headache  Prolactin: repeat test if only slight elevation (21-40 ng/mL)  TSH/T3/T4  MRI: for any elevated PRL  Exception: drug induced hyperprolactinemia Evaluation learnobgyn.com

 1 st line: dopamine agonist (cabergoline > bromocriptine)  ↓ PRL levels + ↓ adenoma size  Nausea, vomiting, orthostatic hypotension, mental fogginess  Not known teratogens  Transsphenoidal surgery  If unable to ↓ PRL, symptoms, adenoma size  Not all tissue excised; may recur  Postoperative radiation  Only used for very large macroadenomas Treatment learnobgyn.com