Hyperprolactinaemia

Question 1

A 46-year-old woman reports that she has been lactating intermittently over the past 2 months. How would you assess her?

Imp/DDx/Goals

Answer 1

Impression:
Intermittent lactation may be a normal presentation for perimenopausal women, but may also be related to hyperprolactinaemia, of which there are a number of potential causes including a prolactinoma to medication side effects (anti-psychotics).

Ddx

• Endocrine: prolactinoma, hyperthyroidism
• Physiological, mechanical irritation, pregnancy
• Medications: anti-psychotics

Goals

• Identify the underlying aetiology of the hyperprolactinaemia with thorough H/E/I
• Initiate appropriate management for the patient

Question 2

Hyperprolactinaemia - History

Answer 2

History

• sx: galactorrhoea (characterise), amenorrhoea,
• occurs with cycle?
• menstrual hx
• associated sx: bitemporal hemianopia, headaches, features of other endocrine disease (cushings, Addisons, thyroid, etc)