Hyperprolactinaemia.

Under tonic inhibitory control from hypothalamus via DE.

Dopamine suppresses prolactin.

Hyperprolactinaemia >400mU/L.

Usually on relevant > 1000.

High levels could be macroadenoma.

 

Presents early in females (amenorrhoea) but late in men.

 

Female presentation.

  • Amenorrhoea.
  • Infertility – anovulatory.
  • Galactorrhoea.
  • Loss of libido.
  • Breast pains.
  • Vaginal dryness.

 

Male presentation.

  • Loss of libido
  • Visual defects- if macro.

Physiological causes.

  • Lactation
  • Pregnancy
  • Stess
  • Repeated breast exam.
  • Sleep

Pathological causes.

  • Drugs
  • Adenomas
  • Hypothyroidism
  • GH (acromegaly)
  • PCOS variant.
  • Liver failure.
  • Renal failure.
  • Sarcoidosis
  • Seizures – to check if pseudo.

Drugs.

Dopamine antagonists

  • Metoclopramide
  • Domperidone
  • Phenothiazines / anti-psychotics.

Adenomas.

Commonest cause.

Many asymptomatic finding.

Women tend have micro (60-70%).

  • Rarely grow.
  • Do not increase in pregnancy.
  • Usually treat medically (Dopamine agonist bromocriptine, cabergoline).

Men tend to have macro - >10mm

High levels of prolactin.

  • Can increase in females in pregnancy in 15% (vision risk) if does can use bromocriptine safely.
  • If wish to become pregnant or causing vision defects, surgery.
  • May not secrete PRL but by pressure effect cause – of DE (thus +).
  • May cause other pituitary defects.

Tests.

  • PRL.
  • TFTs.
  • hcG (pregnancy).
  • Rest of pituitary tests.
  • Oestrogen
  • MRI – will define if micro or macro.
  • Visual fields.

Why treat?

  • Infertility.
  • Amenorrhoea increases osteoporosis.
  • Headaches.
  • Visual loss.
  • Osteoporosis.