Hyperprolactinaemia

Question 1

Hyperprolactinaemia

Raised levels

Function

Answer 1

Most common pituitary disturbance

Prolactin stimulates lactation

Raised levels lead to hypo- gonadism, infertility, and osteoporosis, by inhibiting secretion of gonadotropin-re- leasing hormone (hence LH/FSH and testosterone or oestrogen).

Question 2

Causes

Answer 2

Physiological:

• Pregnancy
• breastfeeding
• stress
• Acute rises occur post-orgasm

Drugs (most common cause):

• Metoclopramide (dopamine antagonist)
• haloperidol
• methyldopa
• oestrogens

Prolactinoma: micro- or macroadenoma

Stalk damage: pituitary adenomas, surgery, trauma,

Hypothalamic disease: craniopharyngioma, other tumours

Question 3

Symptoms

Answer 3

Amenorrohea

Infertility

Galactorrhoea

Osteoporosis

Erectile Dysfunction

Mass effects

Question 4

Investigations

Answer 4

Basal prolactin: non-stressful venepuncture between 09.00 and 16.00h

Do a pregnancy test

TFT, U&E

MRI pituitary if other causes are ruled out.

Question 5

Management

Answer 5

Refer to a specialist endocrinology clinic

Dopamine agonists (bromocriptine or cabergoline) are 1st line

Micro and macroprolactinomas: surgery

Question 6

Effect of dopamine on prolactin

Answer 6

Dopamine inhibits the release of prolactin

That is why a dopamine agonist like bromocriptine are used for hyperprolactinaemia