Hyperprolactanemia

Question 1

Essentials of Dx

Answer 1

Women: oligomenorrhea, amenorrhea; galactorrhea, infertility Men: hypogonadism; decreased libido & erectile dysfunction; infertility

Elevated serum prolactin

CT scan or MRI often demonstrates pituitary adenoma

Question 2

Physiologic Causes

Answer 2

Exercise

Idiopathic

Nipple Stimulation

Pragnancy

Puerperium

Sleep (REM cycle)

Stress (Trauma, surgery)

Suckling

Question 3

Pharmacologic Causes

Answer 3

Amoxapine

Amphetamines

Anesthetic agents

Antipsychotics

Antidepressants

Butyrophenones

Cimetidine & ranitidine

Cocaine

Domperidone

Estrogens

Hydroxyzine

Methyldopa

Metoclopramide

Opioids

Nicotine

Phenothiazines

Protease inhibitors

Reserpine

Risperidone

Testosterone

Verapamil

Question 4

Pathologic Causes

Answer 4

Chronic chest wall stimulation

Cirrhosis

Hypothyroidism

Kidney disease (zinc deficiency)

Multiple sclerosis

Optic neuromyelitis

Pituitary stalk damage

Prolactin-secreting tumors

Pseudocyesis (false pregnancy)

Lupus

Question 5

Diagnostic Workup

Answer 5

Document hyperprolactanemia (at least 1 repeat)

Exclude pregnancy

See PPT for Algorithm

If hyperprolactanemia is suspected, MRI pituitary gland

Question 6

Management

Answer 6

Remove/correct cause

Dopamine agonists

f/u labs

transsphenoidal pituitary surgery