Hyperprolactinaemia in a patient with kidney failure

Amirah Parak,Reyna Daya,Saajidah Bulbulia,Zaheer Bayat,Faheem Seedat

doi:10.21804/23-1-4266

Abstract

Hyperprolactinaemia is a common endocrine abnormality in patients with kidney failure. A 43-year-old female, known with kidney failure on maintenance haemodialysis, was referred with symptomatic hyperprolactinaemia. Biochemical investigations revealed a markedly elevated serum prolactin level. Magnetic resonance imaging of the brain (without gadolinium) demonstrated a pituitary macroadenoma. The patient was started on cabergoline therapy. This case discusses hyperprolactinaemia in kidney failure and highlights the importance of investigating markedly elevated prolactin levels. In cases where patients have galactorrhoea, headaches and/or visual disturbances, clinicians should be alert to the possibility of a prolactin-secreting pituitary tumour.

Highlights

Hyperprolactinaemia is a common biochemical finding associated with pituitary tumours, medication, pituitary stalk disorders, pregnancy, primary hypothyroidism, chestwall lesions and kidney failure [1]
Macroprolactinomas measure more than 10 mm in diameter, whereas microprolactinomas are less than 10 mm [3]
Serum prolactin levels correlate with the aetiology; a prolactin level greater than 250 μg/L is indicative of a prolactinoma whereas a level of more than 500 μg/L is diagnostic of a macroprolactinoma [3]

Summary

INTRODUCTION

Hyperprolactinaemia is a common biochemical finding associated with pituitary tumours, medication, pituitary stalk disorders, pregnancy, primary hypothyroidism, chestwall lesions (in the T4 dermatome) and kidney failure [1]. In patients with hyperprolactinaemia who present with headaches and visual abnormalities, a high index of suspicion should be maintained for a prolactinoma This case report highlights that patients with extremely high prolactin levels, despite kidney failure, need to be investigated for a prolactinoma. A 43-year-old female was referred to the endocrine department for workup of hyperprolactinaemia She reported secondary amenorrhoea for two years, recent onset of headaches, visual disturbances and bilateral galactorrhoea. Regarding her past medical history, she had kidney failure secondary to hypertension and had been treated with chronic haemodialysis (thrice-weekly sessions of 4 hours each) since 2018. A diagnosis of a prolactin-secreting pituitary adenoma (macroprolactinoma) was made and the patient was started on cabergoline therapy

Findings

DISCUSSION

CONCLUSIONS AND LEARNING POINTS