Management of Hyperprolactinemia in Clinical Practice

Abstract

Background & objectives: Hyperprolactinemia is defined as an increased prolactin level above the normal reference range, in women more than 25 ng/dl; with a prevalence rate of 10% in the general population. Hyperprolactinemia is associated with different clinical presentations various from oligomenorrhea, amenorrhea, galactorrhea, and infertility. This study aims to be to assess the current practice regarding the management of hyperprolactinemia in non-pregnant women in the Kurdistan region, Iraq. Subjects and Methods: An electronic questionnaire on current practice concerning diagnosis and treatment of hyperprolactinemia in non-pregnant women was sent through e-mail to 167 clinicians, 166 of them completed the survey and they were from different cities (Duhok, Sulaymaniyah, Erbil, and Halabja) of the Kurdistan region, Iraq. Results: A total of 166 valid questionnaires were collected. The response received from 166 clinicians. Almost 97 % of the responders were asking about the presence of symptoms of prolactinoma in patients with hyperprolactinemia and the majority of responders were made an exclusion of physiological causes related to hyperprolactinemia. When hyperprolactinemia occurred, only 81.3% of the respondents would test for thyroid-stimulating hormone routinely. Majority of the responders (79.5%) did not confirm the biochemical diagnosis of hyperprolactinemia before starting treatment and only two-thirds of them do pituitary imaging. Also, our results show an important role of clinician’s characteristics like age group on the management outcome, as the age group 25-35 was better when compared to the age group 46-55 (p-value =0.044) and the internist specialty and family medicine specialty have a better impact on management outcome in comparison to endocrinologist with (p-value =0.046 and 0.043 respectively). Conclusions: We found that the current clinical practice for the management of hyperprolactinemia is not uniform with some scientific defects. Therefore, it is necessary to develop national guidelines for the management and treatment of hyperprolactinemia.