Hyperprolactinaemia

Question 1

What are the causes of Hyperprolactinaemia?

Answer 1

Excess pituitary production - Pregnancy, breastfeeding, prolactinoma ( >5000)
Disinhibition due to compression of the pituitary stalk - Pituitary adenoma, craniopharyngioma
Dopamine antagonists - Antiemetics - metoclopramide. Antipsychotics - Haloperidol
Domperidone - used for Parkinson’s

Question 2

What are the symptoms of Hyperprolactinaemia?

Answer 2

Amenorrhoea
Infertility
Galactorrhoea
↓ libido 
Erectile dysfunction

Question 3

What investigations can be done in a patient with suspected Hyperprolactinaemia?

Answer 3

Basal prolactin - if > 5000 then most likely due to prolactinoma
Pregnancy test
TFTs
MRI

Question 4

What is the management of Hyperprolactinaemia?

Answer 4

Dopamine agonists eg Cabergoline/ bromocroptine
Decrease prolactin secretion and tumour size as dopamine inhibitory
Side effects - Nausea, lung fibrosis, postural hypotension
Trans-sphenoidal excision if medications don’t relieve visual or pressure symptoms