Hiperprolactinémia – que diagnóstico?

Abstract

Hyperprolactinemia is the most common endocrine alteration of the pituitary‐hypothalamic axis, although its prevalence in the pediatric and adolescent population is not clearly defined yet.In girls the main symptoms are the association of oligomenorrhea, amenorrhea, galactorrhea and infertility. The clinical picture in boys includes gynecomastia, galactorrhea, as well as neuro‐ophthalmologic findings (impaired vision and headache) due to a higher frequency of macroadenomas.There are several etiologies of hyperprolactinemia and medication use is a common cause.A thorough history and physical examination, routine laboratory investigations, thyroid‐stimulating hormone (TSH) determination, and pregnancy test can rule out all causes of hyperprolactinemia except hypothalamus‐pituitary disease.When no evident cause of secondary hyperprolactinemia is found, hypothalamus‐pituitary magnetic resonance imaging (MRI) should be performed. If the MRI is negative the most probable diagnosis is idiopathic hyperprolactinemia.In secondary hyperprolactinemia treatment should be etiologic.Medical treatment with dopamine agonists is currently the treatment of choice for prolactinomas and hypogonadism or other symptoms due to hyperprolactinemia.Transsphenoidal surgery is suitable only when there is resistance or intolerance to dopamine agonists.The autors report four cases of hyperprolactinemia with different etiologies.