Hyperprolactinaemia

Question 1

Symptoms of Hyperprolactinaemia in women?

Answer 1

Amenorrhoea or aligomenorrhoea

Infertility

Galactorrhoea

Also: decreased libido, weight gain, dry vagina

Question 2

Symptoms of Hyperprolactinaemia in men?

Answer 2

Erectile dysfunction, decreased facial hair, galacthorrhoea

Question 3

Tests for hyperprolactinaemia

Answer 3

Basal PRL (prolactin): non stressful venepuncture between 9am and 4pm.

Do a pregnancy test

TFT, U&E

MRI pituitary if other causes are ruled out

Question 4

3 types of causes of raised plasma prolactin (>390mu/L)?

Answer 4

1. Excess production from the pituitary eg prolactinoma
2. Disinhibition, but compression of the pituitary stalk, reducing local dopamine levels
3. use of a dopamine antagonist

Question 5

Physiological causes of hyperprolactinaemia

Answer 5

pregnancy, breastfeeding, stress, acute rises occur post-orgasm

Question 6

Drugs (most common cause) that cause hyperprolactinaemia?

Answer 6

Metoclopramide, haloperidol, methyldopa, oestrogens, ectasy/MDMA, antipsychotics

Question 7

Diseases causing hyperprolactinaemia?

Answer 7

Prolactinoma: micro or macroadenoma

Stalk damage: pituitary adeonomas, surgery, trauma,

hypothalamic disease: craniopharyngioma, other tumours

other: hypothyroidism (due to increased TRH), CKD (decreased excretion)

Question 8

Management of hyperprolactinomas?

Answer 8

Refer to a specialist endocrinology clinic

Dopamine agonists (bromocriptine or cabergoline) are 1st line