Cause Of Hyperprolactinemia Research Articles

A-041 Metoclopramide Stimulation Test can Rule Out Prolactinoma in Patients with Moderate Hyperprolactinemia

Abstract Background Prolactinoma is the main cause of hyperprolactinemia once physiological and pharmacological causes are excluded. Prolactin (PRL) and thyrotropin (TSH) response to dopaminergic antagonists has been previously used in prolactinoma diagnosis. Current guidelines only recommend baseline PRL concentration in diagnosis, considering values exceeding 250 ng/mL highly suggestive of prolactinoma. However, subtler hyperprolactinemia is much more frequent, and magnetic resonance imaging (MRI) studies are necessary to detect potential prolactinomas. Our aim was to examine the utility of a metoclopramide (MCP) stimulation test as a screening tool to evaluate the need for pituitary MRI studies in patients with moderate hyperprolactinemia. Methods We retrospectively selected 67 moderate hyperprolactinemia patients (<250 ng/mL), with a MCP test and a pituitary MRI within the same assistance. We excluded patients with pharmacological treatments affecting dopaminergic axis. According MRI results we classified them in patients with microadenoma (<10 mm; n=23), with macroadenoma (≥10 mm; n=5) or without adenoma (n=39). Maximum relative increases over baseline concentrations were calculated for PRL (ΔPRLMax) and TSH (ΔTSHMax). The Research Ethic Committee approved the study. Results ΔPRLMax exceeds baseline PRL capability to identify patients with an adenoma (AUC=0.8718 vs 0.7756). ΔPRLMax below 220% identifies 100% of these patients with 71% of specificity (Table 1). Screening with MCP test would have avoided 42% of MRI, resulting in 34% costs saving. Analysis of TSH response only slightly increased the specificity when considered as a secondary criterion. Test length can be reduced from 60 to 30 minutes without losing screening capability. Conclusions A shortened MCP test is a useful and cost-effective screening tool to avoid unnecessary MRI. Its simplicity allows its performance in almost any clinical facility, allowing to easily rule out prolactinoma in an important percentage of patients, something of upmost importance specially in regions were MRI facilities are scarce.

Does hyperprolactinemia treatment affect pregnancy and perinatal outcomes?

The aim of this study was to assess obstetric and perinatal outcomes in women with hyperprolactinemia according to the type of treatment indicated, with cabergoline or bromocriptine. A retrospective cohort study with 464 women diagnosed with hyperprolactinemia was undertaken at the endocrine gynecology outpatient clinic of a tertiary hospital from May 2002 to February 2022. All women diagnosed with hyperprolactinemia who were being treated with dopamine agonists (cabergoline or bromocriptine) and who became pregnant during the follow-up were included. Women whose medical records did not provide data related to pregnancy and delivery were excluded. The women were divided into two groups according to the type of treatment: bromocriptine or cabergoline. Clinical and laboratory characteristics and obstetric and perinatal outcomes, such as complications during pregnancy, type of delivery, and intrapartum complications, were evaluated in both groups. Of the 464 women evaluated, 72 became pregnant during the follow-up, 66 of them were using dopamine agonists, while 6 were not using medication. The mean age of the women was 28.3±6.8 years. Among the causes of hyperprolactinemia, 48.6% were idiopathic, 45.7% were tumoral, and 3.7% had other causes. Most women with idiopathic hyperprolactinemia used bromocriptine, while those with tumoral hyperprolactinemia used cabergoline (p=0.04). There was no difference in obstetric outcomes according to the type of treatment used. The majority of women did not have any complications during pregnancy (76.3%) or intrapartum (86.8%). Regardless of the type of previous drug treatment with dopamine agonists, hyperprolactinemia does not alter obstetric outcomes.

Macroprolactin in mothers and their babies: what is its origin?

Macroprolactinemia is one of the major causes of hyperprolactinemia. The aim of this study was to clarify the origin of macroprolactin (macro-PRL). We examined macro-PRL in the sera of 826 pregnant women and in those of their babies' umbilical cords at delivery. Macro-PRL was evaluated by precipitation with polyethylene glycol (PEG), gel filtration chromatography (GFC), and absorption with protein G (PG). We detected macro-PRL in 16 out of the 826 pregnant women (1.94 %) and in 14 of their babies, which may indicate the possibility of hereditary origin of macro-PRL. However, the macro-PRL ratios of the babies correlated positively with those of their mothers (r=0.72 for GFC, p<0.001 and r=0.77 for PG, p<0.001), suggesting that the immunoglobulin (Ig)G-type anti-PRL autoantibodies might be actively transferred to babies via the placenta and form macro-PRL by binding to their babies' PRL or PRL-IgG complexes may possibly pass through the placenta. There were two cases in which only mothers had macro-PRL, indicating that the mothers had autoantibodies that did not pass through the placenta, such as IgA, PRL bound to the other proteins or PRL aggregates. No cases were found in which only the babies had macro-PRL and their mothers did not,suggesting that macro-PRL might not arise by non-hereditary congenital causes. Macro-PRL in women of reproductive age might be mostly IgG-type anti-PRL autoantibody-bound PRL. The likely origin of macro-PRL in babies is the transplacental transfer of IgG-type anti-PRL autoantibodies or PRL-IgG complexes from the mothers to their babies.

Treatment of hyperprolactinemia in women: A Position Statement from the Brazilian Federation of Gynecology and Obstetrics Associations (Febrasgo) and the Brazilian Society of Endocrinology and Metabolism (SBEM).

Dopamine agonists are the first line of treatment for patients with symptomatic hyperprolactinemia due to prolactinomas and in those with idiopathic hyperprolactinemia. Treatment with these agents is effective in 80%-90% of the cases. Infertility treatment of patients with hyperprolactinemia is also carried out with dopamine agonists, aiming for the normalization of prolactin levels. The risk of symptomatic growth of prolactinomas during pregnancy is dependent on the tumor's size, duration of previous treatments, and prolactin levels. Notably, the corresponding risk is relatively low in cases of microprolactinomas (<5%). Remission of hyperprolactinemia occurs in about 30% of the patients after drug treatment and may also occur after pregnancy and menopause. The use of some drugs, such as antidepressants and antipsychotics, is a frequent cause of hyperprolactinemia, and managing this occurrence involves unique considerations. This position statement by the Brazilian Federation of Gynecology and Obstetrics Associations (Febrasgo) and Brazilian Society of Endocrinology and Metabolism (SBEM) addresses the recommendations for measurement of serum prolactin levels and the investigations of symptomatic and asymptomatic hyperprolactinemia and drug-induced hyperprolactinemia in women.

FRI306 Natural History Of Untreated Prolactinoma

Abstract Disclosure: M. Sadek: None. N. Sandila: None. D.B. Clarke: None. S.A. Imran: None. BACKGROUND Prolactinomas (PRLomas) are the most common functioning pituitary tumors, and the majority are microPRLomas (&amp;lt;10 mm in size). Current guidelines do not support treating asymptomatic or minimally symptomatic microPRLomas based on older studies utilizing insensitive imaging and assay techniques, whereas only limited information is available about the natural history of microPRLomas based on new generation assay and advanced imaging modalities. OBJECTIVES This study aims to assess the natural history of medically untreated microPRLomas with regards to long-term trends of serum PRL, tumor growth, clinical symptoms, and their effect on other pituitary function. METHODS We conducted a retrospective review of all patients diagnosed with microPRLoma since 2005 from our comprehensive provincial pituitary registry in Nova Scotia, Canada. Secondary causes of hyperprolactinemia were excluded. Outcomes were extracted at diagnosis and each follow-up visit. PRL, % above upper limit of normal (AULN) and tumor size (mm) were modelled using linear mixed effects models and clinical symptoms were analyzed with McNemar’s Test. Increase in PRL was modeled with exact logistic regression with change in tumor size and symptoms as predictors. RESULTS A total of 28 patients were identified; median age at diagnosis was 37 yrs (IQR 27.5 - 47.5) and median follow-up was 70 months (IQR 41.5 - 123.5). No patient had additional pituitary hormonal abnormality except gonadal dysfunction. Median tumour size at diagnosis was 3 mm (IQR 2 - 4), and median PRL (AULN) was 50% (IQR 15.2 - 113.3). Twenty four (85.7%) had symptoms at diagnosis including: galactorrhea, oligomenorrhea and amenorrhea. At last follow-up, those without symptoms at diagnosis remained asymptomatic and the majority (80%) with symptoms at presentation had complete resolution of symptoms (p&amp;lt;0.01). Only 20% had persistent symptoms, commonest being galactorrhea, but none had worsening of symptoms. There was no evidence of any association between elevated serum prolactin and persistent symptoms. Overall, mean change in tumor size (mm) was -0.9286 (p-value = 0.0138), of which, 2 patients (7%) had an increase since diagnosis (mean increase = 2.5 mm) while the rest (93%) had either no change or a decrease in tumor size. Serum PRL (AULN) when adjusted for change over time (month) over during the entire follow-up period decreased in 20 (71.4%) patients by a median of -0.00793 (IQR -0.01556 - -0.00597) and increased in 8 (28.6%) by a median of 0.00321 (IQR 0.00181 - 0.01549).CONCLUSIONS Although limited by sample size, these findings suggest that when left untreated, the majority of microPRLomas remain stable both in terms of size and PRL values and clinical symptoms resolve in most patients over time. Presentation: Friday, June 16, 2023

Normal intellectual ability and hyperprolactinemia as unique clinical manifestations of congenital hypothyroidism: A case report and review of hypotheses.

Congenital hypothyroidism is the deficiency of thyroid hormone in infants and hyperprolactinemia is frequently observed. Previously reported cases typically involve intellectual disability, highlighting this particular unique case report to the first reported patient demonstrating normal intellectual ability despite experiencing growth and gonad dysfunction. This study aims to present a case and review medical hypotheses related to the patient's condition. A 19-year-old female presented with a chief complaint of irregular menstruation for up to 40 days or not occurring at all. The patient experienced the first menstruation at the age of 16 years old. The patient's height was 133 cm, body weight 40 kg, and body mass index 22.61 kg/m2; other family members were normal. Physical examination showed no abnormalities, and laboratory examination showed suppressed serum free T4 (FT4) level (6.41 pmol/L), elevated thyroid stimulating hormone (TSH) level (333.700 µIU/mL), and elevated prolactin hormone level (32.03 ng/mL). Ultrasound of the thyroid gland found hypoplasia of the left and right thyroid glands. The patient was a college student enrolled in a public national university and had never complained about academic performance throughout the patient's education. The patient was diagnosed with congenital hypothyroidism and hyperprolactinemia. The patient was administered up to 100 µg daily of oral levothyroxine, which improved the patient's menstrual cycles. The patient's delayed diagnosis may be attributed to central congenital hypothyroidism being underdiagnosed. We hypothesized that thyroid-releasing hormone receptor (TRHR) gene mutation might contribute to the underlying cause of hyperprolactinemia and normal intellectual ability of the patient. Further study on the significance of TRHR gene mutations in congenital hypothyroidism is required to improve diagnosis and treatment.

Frequency of drug-associated hyperprolactinaemia: a single-center retrospective study

Objectives: One of the causes of hyperprolactinaemia (HP) is drug-associated HP (DAHP). In this study, it was planned to investigate the frequency of DAHP. Methods: In this study, a retrospective review of 296 individuals referred to the endocrinology outpatient clinic between June 2013 and March 2018 due to elevated prolactin (PRL) was performed. Results: Of the 296 patients included in the study, 140 (47.3%) had HP (+), 80 (27.0%) had HP (-), 27 (9.1%) had DAHP and other causes (16.6%). The causes of DAHP were as follows; sulpiride in 7 (25.9%) patients, risperidone in 6 (22.2%), amisulpride in 4 (14.8%), domperidone in 3 (11.1%), haloperidol in 2 (7.4%), paliperidone, olanzapine, escitalopram, duloxetine and otilonium bromide in one patient each. PRL levels in the DAHP group were higher than in the HP (-) group (respectively; median 114.6 [interquartile range (IQR): 144.0], median 35 [IQR 37.3], p &amp;lt; 0.001). Patients with DAHP had an increased frequency of symptoms compared to the HP (-) group (oligomenorrhoea; 42.3%, 16.4%, p = 0.007, galactorrhoea; 53.8%, 30.1%, p = 0.028, respectively). PRL levels were higher and the frequency of clinical signs was higher in sulpiride than risperidone (PRL; median 195.0 [IQR 99.0], median 72.0 [IQR 57.9], p = 0.022, oligomenorrhoea; 100%, 20%, p = 0.010, respectively). Conclusions: One of the 3 most common causes of patients referred for HP is DAHP and the most common cause of DAHP is anti-psychotic drugs. Sulpiride causes a higher rate of elevated PRL and frequency of clinical findings compared to other drugs.

Neurogenic Hyperprolactinemia

Neurogenic hyperprolactinemia is a rather rare clinical form of hyperprolactinemia, therefore, this pathology may escape the attention of clinicians. At the same time, a high level of prolactin in blood can result in severe metabolic disorders, infertility, decreased bone tissue density, obesity, increased insulin resistance, and poor lipid metabolism. If the disease is not diagnosed in time, it will lead not only to the significantly decreased health and life quality level, but can also contribute to the increased risk of breast cancer formation. The main reason for the development of neurogenic hyperprolactinemia can be various pathological processes in chest, spinal cord and mammary glands. The neurogenic mechanism is triggered by the activation of afferent impulses going to the posterior sections of the spinal cord. The main diagnostic tactics is the exclusion of the most common causes of hyperprolactinemia, identification of the pathological process in the thoracic region, and detection of high prolactin level in the blood serum. Taking the pathogenetic mechanism into account, the treatment of neurogenic hyperprolactinemia consists in eliminating the pathological focus and prescribing dopamine agonists. The purpose of this article is to define the main clinical features associated with the diagnosis and treatment of neurogenic hyperprolactinemia.

Clinical guidelines ‘Hyperprolactinemia’ (draft)

Hyperprolactinemia is a persistent excess of the blood serum prolactin. The syndrome contains various symptoms, the most characteristic is a violation of the reproductive system. There are multiple endogenous and exogenous causes of hyperprolactinemia. The main treatment method is dopamine agonist therapy, in case of prolactinoma existence, surgical and radiation methods can be applied. About 15% of patients are resistant to dopamine agonist therapy, which determines creation of individual management tactics. The article presents a draft of clinical guidelines for the diagnosis and treatment of hyperprolactinemia, which provides a modern examination algorithm, discusses the basic principles of diagnostics and treatment approaches.

Comparison of PEG precipitation and ultrafiltration treatment for serum macroprolactin in Chinese patients with hyperprolactinemia

BackgroundMacroprolactinemia is a common cause of hyperprolactinemia (HPRL), with an average worldwide incidence of 18.9 %. This study aimed to explore the feasibility of ultrafiltration (UF) and polyethylene glycol (PEG) precipitation for macroprolactin screening, as well as the incidence and clinical characteristics of Chinese patients with macroprolactinemia. MethodsIn this study, 94 patients with HPRL and 206 healthy individuals were included. Gel filtration chromatography (GFC), PEG precipitation, and UF were used to screen for macroprolactin, and chemiluminescence was used to determine the prolactin levels. ResultsThe detected incidence of macroprolactinemia in the patients with HPRL was 7.45% (7/94, GFC) and 5.32% (5/94, PEG precipitation). Patients with macroprolactinemia usually present with atypical clinical symptoms, moderately increased prolactin levels, and negative or microadenoma-positive pituitary images. In addition, the recovery of monomeric prolactin by PEG precipitation and UF was significantly correlated to that of GFC (r PEG = 0.493, P < 0.001; r UF = 0.226, P = 0.014), with a higher correlation coefficient between PEG precipitation and GFC. Furthermore, PEG precipitation had a smaller variation (95% confidence interval [CI]: −35.77% to 18.34%) than UF in monomeric prolactin recovery and substantial diagnostic consistency with GFC (Cohen's kappa coefficient = 0.647). The proportion of monomeric prolactin in patients with HPRL did not change significantly between the two visits within one year (P > 0.05). ConclusionThe incidence of macroprolactinemia in Chinese patients with HPRL is low in the present study. Based on our analysis, we recommend that only patients who are clinically suspected of having macroprolactinemia should be screened using PEG precipitation.

Causes of hyperprolactinaemia in the primary care setting: How to optimise hyperprolactinaemia management

Background and purposeTo analyse the causes of hyperprolactinaemia in patients with symptoms compatible with hyperprolactinaemia evaluated in a primary care setting. Patients and methodsA retrospective study of all patients tested for serum prolactin levels between 2019 and 2020 in 20 primary care centres at the Hospital Ramón y Cajal in Madrid. Hyperprolactinaemia is defined as a serum prolactin>19.4ng/ml in men and >26.5ng/ml in women. Aetiology is grouped into physiological (pregnancy, lactation, inadequate venipuncture, macroprolactinaemia), pharmacological, pathological (hypothalamic and/or pituitary diseases, chronic renal failure, primary hypothyroidism), and idiopathic. ResultsIn 1630 patients tested for serum prolactin, 30.7% (n=501) had hyperprolactinaemia. Of these 501 patients, 89.6% were females. 149 patients were referred to the Endocrinology Department and 164 to the Gynaecology Department. Aetiological diagnosis of hyperprolactinaemia was achieved in 411 out of 501 cases. The most frequent cause of hyperprolactinaemia was pharmacological, in 39.1%. The second more frequent cause was idiopathic (29%) and less common were inadequate venipuncture extraction (13.4%), tumour (8.5%) and macroprolactinaemia (3.9%). Patients with tumoural hyperprolactinaemia presented higher serum prolactin levels (87.0±80.19 vs 49.7±39.62ng/ml, P=0.010). In addition, symptoms, such as galactorrhoea (33.3% vs 16.5%, P=0.018), and headache (25.7% vs 13.3%, P=0.045), were more frequent than in patients of the other aetiological groups. ConclusionHyperprolactinaemia is common among patients evaluated in a primary care setting with symptoms of hyperprolactinaemia, but more than 50% of cases are due to pharmacological treatments or improper sample extraction. It is necessary to establish referral protocols to specialised medicine to optimise healthcare resources and avoid unnecessary studies.

DRUG INDUCED HYPER PROLACTINEMIA: INTERESTING OBSERVATIONS.

Introduction: Drugs are a common cause of hyperprolactinemia. It is essential to differentiate this cause from other pathological causes which avoids unnecessary investigations.Thorough history will help us in finding the responsible drug and holding the same will be rewarding. Here we are reporting such cases of drug induced hyperprolactinemia. Methods: It was a cross-sectional observational study. Subjects were recruited from our outpatient department. Hyperprolactinemia was defined as blood prolactin levels &gt;30 ng/mL in females and &gt;24 ng/mL in males, regardless of the presence of symptoms.Serum prolactin was repeated one week after holding the suspected drug(s).Drug induced hyperprolactinemia defined,if holding of responsible drug made normalization of prolactin levels.Results: Total of 32 subjects were studied in this study with age of 35.5±10.8years.Predominantly female subjects were present with female to male ratio 5.4. Basal prolactin was 132±68.7ng/mL and after holding the drug prolactin value was 16.9±8.2. Proton pump inhibitors in combination with prokinetics were the leading cause (71.8%) and followed by multiple drug combinations (15.6%), anti-psychiatric drugs (9.3%) and oral contraceptives (3.1%). The mean prolactin in the combination of levosulpride was 176 ng/dl, whereas with domperidone it was 126 ng/dl &amp; with oral contraceptives, respiridone it was 134,151ng/dl respectively.Conclusion: Majority cases were clinically symptomatic. Among female subjects commonest presentation was galactorrhea followed by irregular menses and breast heaviness and men presented with erectile dysfunction.Contrary to common belief in our study PPI with prokinetic combination is the most common offending agent than anti-psychotic agents. Levosulpride being the most potent drug in inducing hyper prolactinemia than other agents, though the popular belief was with the Risperidone. As the utility of PPI prokinetic combination is increasing, this might replace anti-psychotic agents as most potent &amp; most common etiology for drug induced hyper prolactinemia.

Epidemiological and clinical profiles of Saudi patients with hyperprolactinemia in a single tertiary care center.

Prolactin is a hormone of the pituitary gland whose main function is the production of milk. Hyperprolactinemia is defined as an increase in prolactin levels above 25 μg/L in women and 20 μg/L in men. Causes of hyperprolactinemia include pituitary tumors, especially prolactinomas. Hyperprolactinemia can manifest clinically with a variety of symptoms, including galactorrhea and menstrual irregularities in women and erectile dysfunction in men. There are limited data on the epidemiology of hyperprolactinemia in the Middle East region. Description of the epidemiology and clinical features of hyperprolactinemia in a cohort from Saudi Arabia. Medical record review SETTING: Tertiary medical center in Riyadh PATIENTS AND METHODS: The study included adult patients with hyperprolactinemia in King Abdulaziz Medical City in Riyadh. The patients were treated in endocrinology clinics from 2015 to 2019. Patients of both sexes older than 14 years were enrolled in the study. Patients with insufficient follow-up were excluded. Data were collected on demographic characteristics, symptoms, prolactin level, cause of high prolactin level, and treatment. The frequency of different etiologies and symptoms in patients with hyperprolactinemia. 295 patients RESULTS: The majority of patients with hyperprolactinemia were female 256 (86.8%). Hyperprolactinemia was diagnosed more frequently in patients in the age groups 21-30 years (42.6%) and 31-40 years (24.1%). The majority of the study population was obese or overweight: 136 (46.3%) and 74 (25.2%), respectively. Most of the cases were symptomatic (192, 65.1%). In women, the most common symptom was oligomenorrhea (35%). In men, infertility and erectile dysfunction were the most common clinical symptoms (50% and 44.7%, respectively). Idiopathic causes were the most common etiology (108, 36.6%), followed by pituitary adenomas (81, 27.5%). The majority of patients were treated (184,62.4%), with cabergoline being the most commonly used medication (173, 94.0%). The demographic and clinical presentations and causes of hyperprolactinemia in male and female Saudi patients were similar to that in studies in other populations. Single-center retrospective chart review study. None.

Update in Pathogenesis, Diagnosis, and Therapy of Prolactinoma.

Simple SummaryThis review updates recent advances in the pathogenesis, diagnosis, and therapy of prolactinoma. Prolactinomas, comprising 30–50% of all pituitary neuroendocrine tumors, frequently occur in females aged 20 to 50 and cause hypogonadism and infertility. In typical cases, female patients exhibit galactorrhea and amenorrhea due to serum prolactin (PRL) elevation, and during pregnancy, they should be carefully treated. During diagnosis, other causes of hyperprolactinemia must be excluded, and an MRI is useful for detecting pituitary neuroendocrine tumors. For the treatment of prolactinoma, dopamine agonists are effective in decreasing PRL levels and shrinking tumor size in most patients. Surgical treatment is recommended for patients who are resistant or intolerant to dopamine agonists. This review also discusses giant and malignant prolactinomas, prolactinoma-associated pregnancy, and new therapeutic approaches.Prolactinomas comprise 30–50% of all pituitary neuroendocrine tumors, frequently occur in females aged 20 to 50, and cause hypogonadism and infertility. In typical cases, female patients exhibit galactorrhea and amenorrhea due to serum prolactin (PRL) elevation, and patients during pregnancy should be carefully treated. During diagnosis, other causes of hyperprolactinemia must be excluded, and an MRI is useful for detecting pituitary neuroendocrine tumors. For treating prolactinoma, dopamine agonists (DAs) are effective for decreasing PRL levels and shrinking tumor size in most patients. Some DA-resistant cases and the molecular mechanisms of resistance to a DA are partially clarified. The side effects of a DA include cardiac valve alterations and impulse control disorders. Although surgical therapies are invasive, recent analysis shows that long-term remission rates are higher than from medical therapies. The treatments for giant or malignant prolactinomas are challenging, and the combination of medication, surgery, and radiation therapy should be considered. Regarding pathogenesis, somatic SF3B1 mutations were recently identified even though molecular mechanisms in most cases of prolactinoma have not been elucidated. To understand the pathogenesis of prolactinomas, the development of new therapeutic approaches for treatment-resistant patients is expected. This review updates the recent advances in understanding the pathogenesis, diagnosis, and therapy of prolactinoma.

Hyperprolectinemia in newlyHyperprolectinemia in newly diagnosed Breast cancer in younger (&lt;50) women diagnosed Breast cancer in younger (&lt;50) women

Breast cancer is a common malignancy among women. There are a number of established risk factors for breast cancer in younger population. Hyperprolactinemia is observed to be higher in breast cancer patients. However its presentation in younger (&lt;50 years) women is not well understood. This study was conducted to describe serum prolactin level in newly diagnosed breast cancer patients presented with nipple discharge without any apparent other cause of hyperprolactinemia. The results showed high serum prolactin levels in all these patients. There was no significant correlation observed between serum prolactin and the age of the patients. It was concluded that breast cancer patients presenting with nipple discharge show varying degree of hyperprolactinemia. It requires further studies to explore if it has a causal relationship or it is a feature of breast cancer.

Causes of hyperprolactinaemia in the primary care setting: How to optimise hyperprolactinaemia management

Background and purposeTo analyse the causes of hyperprolactinaemia in patients with symptoms compatible with hyperprolactinaemia evaluated in a primary care setting. Patients and methodsA retrospective study of all patients tested for serum prolactin levels between 2019 and 2020 in 20 primary care centres at the Hospital Ramón y Cajal in Madrid. Hyperprolactinaemia is defined as a serum prolactin>19.4ng/ml in men and >26.5ng/ml in women. Aetiology is grouped into physiological (pregnancy, lactation, inadequate venipuncture, macroprolactinaemia), pharmacological, pathological (hypothalamic and/or pituitary diseases, chronic renal failure, primary hypothyroidism), and idiopathic. ResultsIn 1630 patients tested for serum prolactin, 30.7% (n=501) had hyperprolactinaemia. Of these 501 patients, 89.6% were females. 149 patients were referred to the Endocrinology Department and 164 to the Gynaecology Department. Aetiological diagnosis of hyperprolactinaemia was achieved in 411 out of 501 cases. The most frequent cause of hyperprolactinaemia was pharmacological, in 39.1%. The second more frequent cause was idiopathic (29%) and less common were inadequate venipuncture extraction (13.4%), tumour (8.5%) and macroprolactinaemia (3.9%). Patients with tumoural hyperprolactinaemia presented higher serum prolactin levels (87.0±80.19 vs 49.7±39.62ng/ml, P=0.010). In addition, symptoms, such as galactorrhoea (33.3% vs 16.5%, P=0.018), and headache (25.7% vs 13.3%, P=0.045), were more frequent than in patients of the other aetiological groups. ConclusionHyperprolactinaemia is common among patients evaluated in a primary care setting with symptoms of hyperprolactinaemia, but more than 50% of cases are due to pharmacological treatments or improper sample extraction. It is necessary to establish referral protocols to specialised medicine to optimise healthcare resources and avoid unnecessary studies.

Hyperprolactinemia with antipsychotics and the need for magnetic resonance imaging

IntroductionHyperprolactinemia is a frequent medical condition in daily clinical practice. In most laboratories, normal prolactin (PRL) concentrations are less than 25ng / ml in women and less than 20ng / ml in men. The causes of hyperprolactinemia can be physiological or secondary, among which a differential diagnosis must be made.ObjectivesThe causes of hyperprolactinemia are reviewed on the basis of a clinical case.MethodsBibliographic review and presentation of a clinical case.ResultsThe case of a 17-year-old patient is presented, who comes to the Emergency Department due to a picture of agitation at home. Her relatives comment that two months ago, they began to notice her strange, very active and without the need to sleep. During the examination, the patient presents with verbiage, flight of ideas, and megalomanic thoughts. A manic episode was diagnosed and the patient was admitted to the psychiatric hospital. She was prescribed risperidone up to 4mg / day, carrying out prolactin determination after a few days. The baseline prolactin determination was 140 ng / ml and 130 ng/ml at twenty minutes. Due to the very high levels, the question arises as to whether the cause of hyperprolactinemia is due to treatment or hypothalamic damage. The MRI: “slight asymmetry in the pituitary gland, being discreetly more globular the adenohypophyseal LD, which could be in relation to underlying microadenoma”. As there were no previous data, the decision was made to withdraw risperidone with the introduction of aripiprazole and imaging tests periodically.ConclusionsDifferential diagnosis of the cause of hyperprolactinemia is important.DisclosureNo significant relationships.

Mild hyperprolactinemia in a couple: What impact on fertility?

Mild-to-moderate hyperprolactinemia is a frequent finding in young women presenting with infertility. Prolactin (PRL) concentration should be determined accurately, whether or not the patient has other symptoms suggestive of excess PRL such as galactorrhea or menstrual cycle disorder. After confirmation of persistent hyperprolactinemia on a second blood sample (avoiding conditions known to raise prolactin) and exclusion of macroprolactinemia, prolactinoma and other identifiable non-tumoral causes of hyperprolactinemia must be ruled out. Mildly elevated PRL levels may cause luteal insufficiency in cycling women and are associated with recurrent miscarriage. Any confirmed hyperprolactinemia should be treated in a woman who wishes or fails to become pregnant. Preference is given to cabergoline at the lowest possible dose that normalizes PRL, restoring fertility in the vast majority of cases.Evidence is much less robust in men, in whom PRL concentrations are less prone to increase and the reproductive system is less sensitive to the negative effects of hyperprolactinemia. Nevertheless, chronic and significant hyperprolactinemia in men may impair fertility or cause infertility (with or without hypogonadism) and must be treated, as in women. However, more clinical studies are clearly needed concerning male reproductive function.The significance of mild but persistent hyperprolactinemia in either member of a couple incidentally discovered during assisted reproductive technology (ART) procedures is unclear, and future evidence-based studies are needed to determine whether normalizing prolactin can improve ART outcome.

Evaluation of hyperprolactinemia risk factors in infertile women referred to Yazd Infertility Center: A cross-sectional study.

BackgroundHyperprolactinemia is one of the most common causes of infertility in women. The prevalence of pituitary tumors is 25-30% among infertile participants with hyperprolactinemia.Objective The aim of this study was to describe the causes of hyperprolactinemia in infertile women referred to Yazd Infertility Center.Materials and MethodsThis cross-sectional study was conducted with 182 infertile women with hyperprolactinemia who were referred to Yazd Infertility Center from February 2018 to October 2019. Serum prolactin was assessed by the human prolactin ELISA kit according to the Padtan Gostar Isar protocol. The age, duration of infertility, causes of hyperprolactinemia, and type of infertility treatment were noted. The MRI findings were added.Results The mean age of participants was 28.9 0.36 yr and the prolactin level was 76 8.97 ng/ml. The etiology of hyperprolactinemia among the study participants was 35 participants (19.2%) with pituitary adenoma, 47 participants (25.8%) with polycystic ovary syndrome, 14 participants (7.7%) with pituitary adenoma and polycystic ovary syndrome, and 86 participants (47.3%) with idiopathic hyperprolactinemia. The results of this study showed that there was no statistically significant difference between the mean prolactin levels in participants with different causes of hyperprolactinemia (p = 0.31).ConclusionIdiopathic hyperprolactinemia and polycystic ovary syndrome are the most common reasons for hyperprolactinemia.

Giant cell tumor of the sella as a rare cause of hyperprolactinemia.

Giant cell tumor of the sella as a rare cause of hyperprolactinemia.