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Hyperprolactinemia

Prolactinoma

Hyperprolactinemia is a condition of elevated serum prolactin.


Presentation

  • Frequency United States This condition occurs in less than 1% of the general population and in 5-14% of patients presenting with secondary amenorrhea. [3] Approximately 75% of patients presenting with galactorrhea and amenorrhea have hyperprolactinemia[emedicine.com]
  • We present an immunocompetent pediatric patient who presented with gynecomastia and was found to have hyperprolactinemia. Imaging showed a sphenoid mass and referral was made for a pituitary tumor.[ncbi.nlm.nih.gov]
  • Patients presenting with and without menstruation disorders were evaluated to determine if they presented concomitant hyperprolactinemia.[ncbi.nlm.nih.gov]
  • The present article reports the case of a delusional pregnancy that developed in a drug-naïve young woman affected by paranoid schizophrenia and Hashimoto-related hyperprolactinemia.[ncbi.nlm.nih.gov]
  • A 23-year-old female with Costello syndrome is presented.[ncbi.nlm.nih.gov]
Galactorrhea
  • Patient continued to have galactorrhea, and prolactin level rose for two years without any apparent identified cause, except breast implantation surgery.[ncbi.nlm.nih.gov]
  • One month later, she had oligomenorrhea and galactorrhea. We ruled out all causes of hyperprolactinemia.[ncbi.nlm.nih.gov]
  • She had an uneventful postoperative recovery with complete normalization of her serum prolactin level and resolution of galactorrhea.[ncbi.nlm.nih.gov]
  • Amenorrhea was the most common presenting symptom (49.5%) followed by galactorrhea (44.3%). Median initial serum prolactin level was 117 ng/mL (25.1-1,624 ng/mL).[ncbi.nlm.nih.gov]
  • They typically present with oligomenorrhea, amenorrhea, galactorrhea, or infertility. Galactorrhea is less common in postmenopausal women due to lack of estrogen.[emedicine.com]
Weight Gain
  • Moreover, hyperprolactinemia has been linked to weight gain and insulin resistance, which can be ameliorated following medical treatment.[ncbi.nlm.nih.gov]
  • A 38-year-old white female patient seeks medical attention complaining of weight gain (Body mass index: 35) associated with anxiety. She started sibutramine treatment and presented with amenogalactorrhea.[ncbi.nlm.nih.gov]
  • KEYWORDS: Metabolic abnormalities; Prolactin; Weight gain[ncbi.nlm.nih.gov]
  • The principal concern for endocrinologists with the newer drugs has been the metabolic effects of weight gain, glucose intolerance, hyperlipidemia, and hypertension [ 2 ].[ijpeonline.biomedcentral.com]
Short Stature
  • In this paper we describe six patients with macroprolactinemia, one of whom was asymptomatic and the other five either had headache, menstrual disturbance, short stature, increased hair growth or early puberty, compatible with high PRL levels.[ncbi.nlm.nih.gov]
  • GH insensitivity (GHI) syndrome caused by STAT5B mutations was recently reported, and it is characterized by extreme short stature and immune dysfunction.[ncbi.nlm.nih.gov]
  • MATERIAL AND METHODS: The analysis comprised a group of 44 children (32 boys and 12 girls, aged from 4.2 to 14.1 years, mean SD: 10.4 3.5 years) with either short stature or precocious puberty, with an elevated Prl concentration at 8:00 a.m., suggesting[ncbi.nlm.nih.gov]
Cushingoid
  • Abstract A 38-year-old woman was admitted to our hospital because of amenorrhea, multiple bone fractures, and a Cushingoid appearance.[ncbi.nlm.nih.gov]
Coarse Facial Features
  • She had mental retardation, macrocephalia, "coarse" facial features, deep palmar and plantar creases, hyperkeratosis in palms and soles, hyperpigmentation, curly hair, and cutis laxa, which are among the diagnostic features of the syndrome, and a history[ncbi.nlm.nih.gov]
Hyperkeratosis
  • She had mental retardation, macrocephalia, "coarse" facial features, deep palmar and plantar creases, hyperkeratosis in palms and soles, hyperpigmentation, curly hair, and cutis laxa, which are among the diagnostic features of the syndrome, and a history[ncbi.nlm.nih.gov]
Cutis Laxa
  • She had mental retardation, macrocephalia, "coarse" facial features, deep palmar and plantar creases, hyperkeratosis in palms and soles, hyperpigmentation, curly hair, and cutis laxa, which are among the diagnostic features of the syndrome, and a history[ncbi.nlm.nih.gov]
Increased Hair Growth
  • In this paper we describe six patients with macroprolactinemia, one of whom was asymptomatic and the other five either had headache, menstrual disturbance, short stature, increased hair growth or early puberty, compatible with high PRL levels.[ncbi.nlm.nih.gov]
Purpura
  • Hormonal and immunological evaluations were performed in two male siblings with GHI associated with atopic eczema, interstitial lung disease, and thrombocytopenic purpura. STAT5B genes were directly sequenced.[ncbi.nlm.nih.gov]
Hyperpigmentation
  • She had mental retardation, macrocephalia, "coarse" facial features, deep palmar and plantar creases, hyperkeratosis in palms and soles, hyperpigmentation, curly hair, and cutis laxa, which are among the diagnostic features of the syndrome, and a history[ncbi.nlm.nih.gov]
Decreased Libido
  • Symptoms In men, hyperprolactinemia may be associated with decreased libido, impotence, visual disturbances, gynecomastia (breast development) or reduced beard growth.[myfertility.ca]
  • In women it is usually associated with galactorrhea and secondary amenorrhea; in men it may be a factor in gynecomastia, decreased libido, and impotence.[medical-dictionary.thefreedictionary.com]
  • In males, symptoms include decreased libido, erectile dysfunction, other signs of hypogonadism, and local symptoms from an expanding pituitary tumor.[touchendocrinology.com]
  • Clinical presentation of hyperprolactinemia (2) Men          Decreased libido Impotence – unresponsive to testosterone treatment Decreased sperm production Infertility Gynecomastia Rarely galactorrhea Decreased muscle mass Body hair Osteoporosis[slideshare.net]
  • Indications for men: Perform a lab test for prolactin for men with hypogonadism, gynecomastia, galactorrhoea, decreased libido and erectile dysfunction.[urology-textbook.com]
Nipple Discharge
  • A 20-year-old man presented to a local physician because of a milky nipple discharge of 2 months' duration. He was otherwise healthy. Findings on physical examination were unremarkable except for the milky discharge from both nipples on expression.[ncbi.nlm.nih.gov]
  • She denies hirsutism and acne but admits to thin milky nipple discharge upon squeezing (but not spontaneous).[mdedge.com]
  • The day before her next injection, the patient complained of nipple discharge and breast tenderness, leading to a check of her prolactin level.[healio.com]
  • Nipple discharge Rule out breast pathology (by history, physical examination, mammography) Galactorrhea 11. Step 1. Galactorrhea Evaluation for breast tumor     Unilateral Single duct Bloody or Serosanguineous Associated with breast mass 12.[slideshare.net]
  • There are, however, gender-specific symptoms… Symptoms of Hyperprolactinemia For Women : irregular nipple discharge breast milk production in the absence of pregnancy (Galactorrhea) irregular menstrual cycles including amenorrhea (absent period) and luteal[natural-fertility-info.com]
Headache
  • We present two cases. (1) A 35-year-old woman suffering from chronic tension-type headache interspersed with occasional episodes of migraine without aura (as defined by the International Headache Society criteria).[ncbi.nlm.nih.gov]
  • A 31-year-old woman presented 12 months after discontinuing the oral contraceptive pill with progressive headache to her primary-care physician.[ncbi.nlm.nih.gov]
  • However, sedation, insomnia, and headache were more frequent when the adjunctive aripiprazole dose was higher than 15 mg/day.[ncbi.nlm.nih.gov]
  • Abstract OBJECT Spontaneous intracranial hypotension is an increasingly recognized cause of headaches. Pituitary enlargement and brain sagging are common findings on MRI in patients with this disorder.[ncbi.nlm.nih.gov]
  • An 11-year-old girl presented with excessive growth, headache, left visual loss and seizures. Her growth hormone (GH) and prolactin (PRL) levels were high and magnetic resonance imaging findings showed an invasive macroadenoma.[ncbi.nlm.nih.gov]
Aura
  • We present two cases. (1) A 35-year-old woman suffering from chronic tension-type headache interspersed with occasional episodes of migraine without aura (as defined by the International Headache Society criteria).[ncbi.nlm.nih.gov]
Amenorrhea
  • Frequency United States This condition occurs in less than 1% of the general population and in 5-14% of patients presenting with secondary amenorrhea. [3] Approximately 75% of patients presenting with galactorrhea and amenorrhea have hyperprolactinemia[emedicine.com]
  • Amenorrhea was the most common presenting symptom (49.5%) followed by galactorrhea (44.3%). Median initial serum prolactin level was 117 ng/mL (25.1-1,624 ng/mL).[ncbi.nlm.nih.gov]
  • We report a case in which hyperprolactinemia and amenorrhea under the treatment with olanzapine gets normalized after the addition of aripiprazole.[ncbi.nlm.nih.gov]
  • J Hum Reprod Sci 2010;3:111-2 Amenorrhea with infertility has long been challenging to the treating physician. A high prolactin level is encountered in about one- third of women with no obvious cause of amenorrhea.[dx.doi.org]
  • INTRODUCTION: Hyperprolactinemia is a prevalent cause of oligo-amenorrhea, and prolactinomas are the most common type of functional pituitary tumor. Untreated hyperprolactinemia can lead to bone loss and impair gonadal function and fertility.[ncbi.nlm.nih.gov]
Oligomenorrhea
  • One month later, she had oligomenorrhea and galactorrhea. We ruled out all causes of hyperprolactinemia.[ncbi.nlm.nih.gov]
  • Here, we report data from three sisters with hyperprolactinemia, two of whom presented with oligomenorrhea and one with infertility.[ncbi.nlm.nih.gov]
  • KEYWORDS: Cabergoline; dopamine agonist; hyperprolactinemia; oligomenorrhea[ncbi.nlm.nih.gov]
  • Hyperprolactinemia is known to cause amenorrhea, oligomenorrhea, galactorrhea and gynecomastia in females and is also associated with sexual dysfunction and bone loss.[ncbi.nlm.nih.gov]
  • Baseline prolactin levels, frequency of galactorrhea, amenorrhea, oligomenorrhea, erectile dysfunction, infertility, and visual impairment were similar between the two groups, whereas the baseline tumor volume was higher in the CAB group.[ncbi.nlm.nih.gov]
Sexual Dysfunction
  • Serum prolactin level, menstrual disturbances, sexual dysfunction, psychopathologies, and quality of life were measured at weeks 0, 1, 2, 4, 6, and 8.[ncbi.nlm.nih.gov]
  • The psychopathology was evaluated using the Positive and Negative Syndrom Scale (PANSS), and sexual dysfunction was evaluated using the Arizona Sexual Experiences Scale (ASEX).[ncbi.nlm.nih.gov]
  • Sexual dysfunction was significantly higher in HPRL patients than in non-HPRL patients (79.17% vs 51.72%) (P 0.006), and mean prolactin values were significantly higher in case of SED (P 0.020).[ncbi.nlm.nih.gov]
  • dysfunction and found no difference between men and women in the prevalence of sexual dysfunction in such cases. [7] A study by Ishioka et al indicated that in men receiving antipsychotic agents, a link exists between hyperprolactinemia and an increase[emedicine.com]
  • Hyperprolactinemia is known to cause amenorrhea, oligomenorrhea, galactorrhea and gynecomastia in females and is also associated with sexual dysfunction and bone loss.[ncbi.nlm.nih.gov]
Secondary Amenorrhea
  • Frequency United States This condition occurs in less than 1% of the general population and in 5-14% of patients presenting with secondary amenorrhea. [3] Approximately 75% of patients presenting with galactorrhea and amenorrhea have hyperprolactinemia[emedicine.com]
  • In women it is usually associated with galactorrhea and secondary amenorrhea; in men it may be a factor in gynecomastia, decreased libido, and impotence.[medical-dictionary.thefreedictionary.com]
  • Methods: We retrospectively evaluated our outpatient admission records for PCOS, hirsutism, oligomenorrhea, or secondary amenorrhea. PCOS diagnosis was made after excluding other causes of hirsutismus and in accordance with Rotterdam criteria.[endocrine-abstracts.org]
Vaginal Dryness
  • dryness When occurring in men, the symptoms typically involve sexual dysfunction and/or pain associated with the formation of the prolactinoma.[pcos.about.com]
  • In women: cessation of menstrual periods (amenorrhea), decreased menstrual flow (oligomenorrhea), abnormal production of breast milk when not breastfeeding (galactorrhea), excess facial hair (hirsutism), vaginal dryness and pain during intercourse and[healthcommunities.com]
  • In addition, women may have: Vaginal dryness, leading to pain during intercourse Problems with menstruation—having no periods or irregular periods Production of breast milk when not pregnant or nursing Men may also have: Erectile dysfunction—trouble getting[hormone.org]

Workup

  • In eight (5.5%) patients with MaPRL, only one had pituitary microadenoma on radiological workup.[ncbi.nlm.nih.gov]
  • Therefore, the authors would suggest screening for pituitary tumors and evaluate prolactin levels in the workup of GM patients without a recent history of lactation and pregnancy and no other identified etiology.[ncbi.nlm.nih.gov]
  • A pregnancy history should be taken before further workup to rule out pregnancy-related galactorrhea.[aafp.org]
Prolactin Increased
  • The level of Prolactin increases in the Blood than the normal level. This leads to Hyperlactation, Menstrual Problems and Galactorrhea.[herbpathy.com]
  • In a limited number of cases where prolactin increase is caused by pituitary tumors larger than 10 mm that do not improve with drugs, the possibility of performing a surgery or radiation treatment must be evaluated.[ingenes.com]
  • Kruger TH et al have demonstrated that sexual intercourse with orgasm induced not only the well-established immediate prolactin increasing of 300% but also an additional prolactin elevation around noon of the next day.[intechopen.com]

Treatment

  • In the first week of quinagolide treatment, 12 patients reported nausea and postural hypotension, which spontaneously disappeared during the second-third week of treatment. None of the 39 patients reported side-effects during CAB treatment.[ncbi.nlm.nih.gov]
  • CAB treatment was tolerated better than quinagolide treatment in 12 out of 39 patients (30.7%).[doi.org]
  • […] recurrence, and pregnancy after treatment.[ncbi.nlm.nih.gov]
  • Eur J Endocrinol 138 : 286–293 72 Colao A et al. (2004) Outcome of cabergoline treatment in men with prolactinoma: effects of a 24-month treatment on prolactin levels, tumor mass, recovery of pituitary function, and semen analysis.[doi.org]
  • Discussion focuses on the efficacy and safety of available treatments and comments on new and emerging therapies. EXPERT OPINION: Dopamine agonists, usually cabergoline, remain the primary choice for initial treatment of hyperprolactinemia.[ncbi.nlm.nih.gov]

Prognosis

  • Prognosis and outcome Prognosis of Management Options Observation Patients who select observation can be counseled that up to 95% of microadenomas remain stable over time.[clinicaladvisor.com]
  • No evidence is yet available of the potential impact of this information on disease management and prognosis. These sophisticated tests are only available at some centers.[elsevier.es]
  • Patients opting for this approach had often failed other management options and may have had a worse prognosis that was independent of the treatment; this selection bias may underestimate the effectiveness of surgery.[systematicreviewsjournal.biomedcentral.com]

Etiology

  • It is sometimes difficult to differentiate the etiology of hyperprolactinemia from a clinical perspective. Identification of the etiology of hyperprolactinemia requires a careful review of the causes and appropriate work-up.[ncbi.nlm.nih.gov]
  • Granulomatous mastitis (GM) is a relatively uncommon inflammatory breast lesion with multiple suggested etiologies.[ncbi.nlm.nih.gov]
  • The etiology and treatment options of IGM remain controversial. Previous case reports have suggested that hyperprolactinemia may be associated with IGM.[ncbi.nlm.nih.gov]
  • An individualized treatment should be initiated after the diagnosis of hypertension and underlying etiology. Many metabolic and endocrinal abnormalities are encountered in CRF.[ncbi.nlm.nih.gov]
  • A number of case reports have been published in the literature; however, the etiology remains unclear. A case is presented of a unilateral galactocele associated with transient hyperprolactinemia after augmentation mammoplasty.[ncbi.nlm.nih.gov]

Epidemiology

  • Epidemiology References: [1] [2] Epidemiological data refers to the US, unless otherwise specified.[amboss.com]
  • Epidemiology Prevalence Predominant age: reproductive age Predominant sex: female male More readily detected in females because a slight elevation in prolactin causes changes in menstruation and galactorrhea Etiology and Pathophysiology Prolactin, which[unboundmedicine.com]
  • Women with naturally higher prolactin levels have higher risk of breast cancer according to a large epidemiologic study.[rainbow.coop]
  • Epidemiologic features An excess of prolactin above a reference laboratory's upper limits, or “biochemical hyperprolactinemia,” can be identified in up to 10% of the population. 1 Women with oligomenorrhea, amenorrhea, galactorrhea or infertility, and[cmaj.ca]
  • However, the role of PRL in human prostate pathology is not clarified and epidemiological data on PRL and risk of prostate cancer is sparse ( 15 , 16 ).[eje.bioscientifica.com]
Sex distribution
Age distribution

Pathophysiology

  • Dopamine is the most important prolactin-inhibiting factor, and dopaminergic hyperactivity has been implicated in the pathophysiology of psychosis.[ncbi.nlm.nih.gov]
  • The clinical, laboratory, and imaging findings of the case are reviewed, and the embryogenesis of the pituitary gland, the pathophysiologic features of this condition, the diagnosis, and the treatment options are discussed.[ncbi.nlm.nih.gov]
  • We added to the selected articles additional articles, including 28 articles regarding the latest international guidelines, the pathophysiology of hyperprolactinemia and the various therapeutic choices.[ncbi.nlm.nih.gov]
  • While the definitive pathophysiologic link remains to be elucidated and could have been assisted by removal of the prostheses, the patient declined to have the implants removed.[ncbi.nlm.nih.gov]
  • References: [1] [2] [3] [4] Pathophysiology Clinical features Patients with hyperprolactinemia due to a pituitary adenoma may also present with bitemporal hemianopsia and headache (see section on “Clinical features of pituitary adenomas ”) References:[amboss.com]

Prevention

  • SELECTION CRITERIA: Randomized controlled trials (RCTs) in all languages examining the effect of dopamine agonists on preventing future miscarriage.[ncbi.nlm.nih.gov]
  • Recognition and treatment of this condition including switching to a prolactin-sparing agent are important to prevent this complication.[ncbi.nlm.nih.gov]
  • The major objectives of treating prolactinomas are to suppress excessive hormone secretion and its clinical consequences, to remove the tumor mass while preserving the residual pituitary function, and possibly to prevent disease recurrence or progression[ncbi.nlm.nih.gov]
  • Given the potentially harmful consequences of hyperprolactinemia and its preventable nature, effective measures to lower the frequency hyperprolactinemia in patients with major psychiatric disorders should be implemented in Chinese mental health facilities[ncbi.nlm.nih.gov]
  • The submuscular location of the implant, which in theory is less likely to cause direct stimulation of the breast compared to subglandular placement, did not prevent prolactin elevation in our patient.[ncbi.nlm.nih.gov]

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Last updated: 2018-06-22 05:43