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CC BY-NC-ND 4.0 · Ibnosina Journal of Medicine and Biomedical Sciences 2020; 12(02): 90-97
DOI: 10.4103/ijmbs.ijmbs_38_20
Review Article

A rational approach to the evaluation and management of patients with hyperprolactinemia

Khaled Aldahmani
1   Department of Endocrinology, Tawam Hospital
2   Department of Medicine, College of Medicine and Health Sciences, UAE University, Al Ain
,
Mussa AlMalki
3   Obesity, Endocrine and Metabolism Center, King Fahad Medical City
4   Department of Medicine, Faculty of Medicine, King Saud Bin Abdul Aziz University of Health Sciences, Riyadh
,
Salem Beshyah
5   Department of Medicine, Dubai Medical College
6   Department of Endocrinology, Mediclinic Airport, Abu Dhabi
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Prolactin has multiple biological functions. Hyperprolactinemia is a common condition in clinical practice both in women and men. It has multiple etiologies and may present with variable symptoms to different health-care providers. Therefore, a rational and systematic approach is paramount when evaluating patients with hyperprolactinemia to arrive at the correct diagnosis and institute the appropriate therapy. We here review the etiology, clinical presentation, and differential diagnosis of hyperprolactinemia and present a practical plan for further evaluation and management. It is most essential to establish the diagnosis and need for the treatment of patients with micro- and macro-prolactinomas and identify when only observation may be warranted. The biological, medical, and social contexts have to be considered to make the appropriate management decisions on an individual basis.

Key-words:

Cabergoline - hyperprolactinemia - pituitary tumors - prolactin

Financial support and sponsorship

Nil.




Publication History

Received: 03 April 2020

Accepted: 10 April 2020

Article published online:
07 July 2022

© 2020. The Libyan Authority of Scientific Research and Technologyand the Libyan Biotechnology Research Center. All rights reserved. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License,permitting copying and reproductionso long as the original work is given appropriate credit. Contents may not be used for commercial purposes, oradapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Bernard V, Young J, Binart N. Prolactin–A pleiotropic factor in health and disease. Nat Rev Endocrinol 2019;15:356-65.
  • 2 Freda PU, Wardlaw SL, Post KD. Unusual causes of sellar/parasellar masses in a large transsphenoidal surgical series. J Clin Endocrinol Metab 1996;81:3455-9.
  • 3 Vilar L, Freitas MC, Naves LA, Casulari LA, Azevedo M, Montenegro R Jr, et al. Diagnosis and management of hyperprolactinemia: Results of a brazilian multicenter study with 1234 patients. J Endocrinol Invest 2008;31:436-44.
  • 4 Malik AA, Aziz F, Beshyah SA, Aldahmani KM. Aetiologies of Hyperprolactinaemia: A retrospective analysis from a tertiary healthcare centre. Sultan Qaboos Univ Med J 2019;19:e129-e134.
  • 5 Soto-Pedre E, Newey PJ, Bevan JS, Greig N, Leese GP. The epidemiology of hyperprolactinaemia over 20 years in the tayside region of scotland: The prolactin epidemiology, audit and research study (PROLEARS). Clin Endocrinol (Oxf) 2017;86:60-7.
  • 6 Melmed S, Casanueva FF, Hoffman AR, Kleinberg DL, Montori VM, Schlechte JA, et al. Diagnosis and treatment of hyperprolactinemia: An Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2011;96:273-88.
  • 7 Serri O, Chik CL, Ur E, Ezzat S. Diagnosis and management of hyperprolactinemia. CMAJ 2003;169:575-81.
  • 8 Samperi I, Lithgow K, Karavitaki N. Hyperprolactinaemia. J Clin Med. 2019;13;8:2203.
  • 9 Fahie-Wilson M, Smith TP. Determination of prolactin: The macroprolactin problem. Best Pract Res Clin Endocrinol Metab 2013;27:725-42.
  • 10 Luciano AA. Clinical presentation of hyperprolactinemia. J Reprod Med 1999;44:1085-90.
  • 11 Verhelst J, Abs R. Hyperprolactinemia: Pathophysiology and management. Treat Endocrinol 2003;2:23-32.
  • 12 Di Somma C, Colao A, Di Sarno A, Klain M, Landi ML, Facciolli G, et al. Bone marker and bone density responses to dopamine agonist therapy in hyperprolactinemic males. J Clin Endocrinol Metab 1998;83:807-13.
  • 13 Schlechte J, el-Khoury G, Kathol M, Walkner L. Forearm and vertebral bone mineral in treated and untreated hyperprolactinemic amenorrhea. J Clin Endocrinol Metab 1987;64:1021-6.
  • 14 Greenman Y, Tordjman K, Stern N. Increased body weight associated with prolactin secreting pituitary adenomas: Weight loss with normalization of prolactin levels. Clin Endocrinol (Oxf) 1998;48:547-53.
  • 15 Mann WA. Treatment for prolactinomas and hyperprolactinaemia: A lifetime approach. Eur J Clin Invest 2011;41:334-42.
  • 16 Vilar L, Fleseriu M, Bronstein MD. Challenges and pitfalls in the diagnosis of hyperprolactinemia. Arq Bras Endocrinol Metabol 2014;58:9-22.
  • 17 Kars M, Dekkers OM, Pereira AM, Romijn JA. Update in prolactinomas. Neth J Med 2010;68:104-12.
  • 18 Liu JK, Couldwell WT. Contemporary management of prolactinomas. Neurosurg Focus 2004;16:E2.
  • 19 Molitch ME. Disorders of prolactin secretion. Endocrinol Metab Clin North Am 2001;30:585-610.
  • 20 Prabhakar VK, Davis JR. Hyperprolactinaemia. Best Pract Res Clin Obstet Gynaecol 2008;22:341-53.
  • 21 Hekimsoy Z, Kafesçiler S, Güçlü F, Ozmen B. The prevalence of hyperprolactinaemia in overt and subclinical hypothyroidism. Endocr J 2010;57:1011-5.
  • 22 Sharma LK, Sharma N, Gadpayle AK, Dutta D. Prevalence and predictors of hyperprolactinemia in subclinical hypothyroidism. Eur J Intern Med 2016;35:106-10.
  • 23 Kelver ME, Nagamani M. Hyperprolactinemia in primary adrenocortical insufficiency. Fertil Steril 1985;44:423-5.
  • 24 Milewicz A. Prolactin levels in the polycystic ovary syndrome. J Reprod Med 1984;29:193-6.
  • 25 Delcour C, Robin G, Young J, Dewailly D. PCOS and Hyperprolactinemia: What do we know in 2019? Clin Med Insights Reprod Health 2019;13:1179558119871921.
  • 26 Kyritsi EM, Dimitriadis GK, Angelousi A, Mehta H, Shad A, Mytilinaiou M, et al. The value of prolactin in predicting prolactinoma in hyperprolactinemic polycyctic ovarian syndrome. Eur J Clin Invest 2018;48:e12961.
  • 27 Sluijmer AV, Lappöhn RE. Clinical history and outcome of 59 patients with idiopathic hyperprolactinemia. Fertil Steril 1992;58:72-7.
  • 28 Alosaimi FD, Fallata EO, Abalhassan M, Alhabbad A, Alzain N, Alhaddad B, et al. Prevalence and risk factors of hyperprolactinemia among patients with various psychiatric diagnoses and medications. Int J Psychiatry Clin Pract 2018;22:274-81.
  • 29 Schlechte JA. Long-term management of prolactinomas. J Clin Endocrinol Metab 2007;92:2861-5.
  • 30 Liu JK, Couldwell WT. Contemporary management of prolactinomas. Neurosurg Focus 2004;16:E2.
  • 31 Halperin Rabinovich I, Cámara Gómez R, García Mouriz M, Ollero García-Agulló D, Grupo de Trabajo de Neuroendocrinología de la SEEN. Clinical guidelines for diagnosis and treatment of prolactinoma and hyperprolactinemia. Endocrinol Nutr 2013;60:308-19.
  • 32 Colao A. Pituitary tumours: The prolactinoma. Best Pract Res Clin Endocrinol Metab 2009;23:575-96.
  • 33 Gillam MP, Molitch ME, Lombardi G, Colao A. Advances in the treatment of prolactinomas. Endocr Rev 2006;27:485-534.
  • 34 Beshyah SA, Sherif IH, Chentli F, Hamrahian A, Khalil AB, Raef H, et al. Management of prolactinomas: A survey of physicians from the Middle East and North Africa. Pituitary 2017;20:231-40.
  • 35 Sisam DA, Sheehan JP, Schumacher OP. Lack of demonstrable tumor growth in progressive hyperprolactinemia. Am J Med 1986;80:279-80.
  • 36 Celik E, Ozkaya HM, Poyraz BC, Saglam T, Kadioglu P. Impulse control disorders in patients with prolactinoma receiving dopamine agonist therapy: A prospective study with 1 year follow-up. Endocrine 2018;62:692-700.
  • 37 Dekkers OM, Lagro J, Burman P, Jørgensen JO, Romijn JA, Pereira AM. Recurrence of hyperprolactinemia after withdrawal of dopamine agonists: Systematic review and meta-analysis. J Clin Endocrinol Metab 2010;95:43-51.
  • 38 Glezer A, Bronstein MD. Prolactinomas. Endocrinol Metab Clin N Am 2015;44:71–8.
  • 39 Gillam MP, Molitch ME, Lombardi G, Colao A. Advances in the treatment of prolactinomas. Endocr Rev 2006;27:485-534.
  • 40 Vroonen L, Jaffrain-Rea ML, Petrossians P, Tamagno G, Chanson P, Vilar L, et al. Prolactinomas resistant to standard doses of cabergoline: A multicenter study of 92 patients. Eur J Endocrinol 2012;167:651-62.
  • 41 Primeau V, Raftopoulos C, Maiter D. Outcomes of transsphenoidal surgery in prolactinomas: Improvement of hormonal control in dopamine agonist-resistant patients. Eur J Endocrinol 2012;166:779-86.
  • 42 Sudhakar N, Ray A, Vafidis JA. Complications after trans-sphenoidal surgery: Our experience and a review of the literature. Br J Neurosurg 2004;18:507-12.
  • 43 Rush SC, Newall J. Pituitary adenoma: The efficacy of radiotherapy as the sole treatment. Int J Radiat Oncol Biol Phys 1989;17:165-9.
  • 44 Grossman A, Besser M, Wass J, Rees L. Treatment of prolactinomas with megavoltage radiotherapy. Br Med J (Clin Res Ed) 1984;288:2002.
  • 45 Pouratian N, Sheehan J, Jagannathan J, Laws Jr., ER, Steiner L, Vance ML. Gamma knife radiosurgery for medically and surgically refractory prolactinomas. Neurosurgery 2006;59:255-66.
  • 46 Wilson PJ, Williams JR, Smee RI. Single-centre experience of stereotactic radiosurgery and fractionated stereotactic radiotherapy for prolactinomas with the linear accelerator. J Med Imaging Radiat Oncol 2015;59:371-8.
  • 47 Sheehan JP, Niranjan A, Sheehan JM, Jane JA Jr., Laws ER, Kondziolka D, et al. Stereotactic radiosurgery for pituitary adenomas: An intermediate reviewof its safety, efficacy, and role in the neurosurgical treatment armamentarium. J Neurosurgery 2005;102:678-91.
  • 48 Snyder PJ, Fowble BF, Schatz NJ, Savino PJ, Gennarelli TA. Hypopituitarism following radiation therapy of pituitary adenomas. Am J Med 1986;81:457-62.