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==Hyperprolactinemia resident survival guide== | ==Hyperprolactinemia resident survival guide== | ||
===Overview=== | ===Overview=== | ||
This section provides a short and straight to the point overview of the hyperprolactinemia. | This section provides a short and straight to the point overview of the [[hyperprolactinemia]]. | ||
===Causes=== | ===Causes=== | ||
====Life-threatening Causes==== | ====Life-threatening Causes==== | ||
Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated. | Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated. | ||
* Severe burns on the chest can cause hyperprolactinemia due to neural stimulation similar to suckling. | * Severe [[Burn|burns]] on the chest can cause [[hyperprolactinemia]] due to neural stimulation similar to suckling. | ||
====Common Causes==== | ====Common Causes==== | ||
* Pregnancy | *[[Pregnancy]] | ||
* Lactation | *[[Lactation]] | ||
* Prolactinoma | *[[Prolactinoma]] | ||
* Injury to dopaminergic neurons in the hypothalamus (sarcoidosis, craniopharyngioma, and metastatic brain carcinoma) | * Injury to dopaminergic neurons in the hypothalamus ([[sarcoidosis]], [[craniopharyngioma]], and metastatic brain carcinoma) | ||
* Section of the hypothalamic-pituitary stalk | * Section of the hypothalamic-pituitary stalk | ||
* Antipsychotics (risperidone, haloperidol, and phenothiazine) | * Antipsychotics ([[risperidone]], [[haloperidol]], and [[phenothiazine]]) | ||
* Selective serotonin reuptake inhibitors | * Selective serotonin reuptake inhibitors | ||
* Metoclopramide | *[[Metoclopramide]] | ||
* Domperidone | *[[Domperidone]] | ||
* Methyldopa | *[[Methyldopa]] | ||
* Verapamil | *[[Verapamil]] | ||
* Familial hyperprolactinemia | * Familial hyperprolactinemia | ||
* Hypothyroidism | *[[Hypothyroidism]] | ||
* Chronic renal failure | *[[Chronic renal failure]] | ||
* macroprolactinomas | * macroprolactinomas | ||
* Exercise | *[[Physical exercise|Exercise]] | ||
===Evaluation=== | ===Evaluation=== | ||
Shown below is an algorithm summarizing the diagnosis of [[hyperprolactinemia]] according to an Endocrine Society Clinical Practice guidelines | Shown below is an algorithm summarizing the diagnosis of [[hyperprolactinemia]] according to an Endocrine Society Clinical Practice guidelines: | ||
{{Family tree/start}} | {{Family tree/start}} | ||
{{Family tree | | | | A01 | | | |A01= Suggestive symptoms including headache, oligomenorrhea, infertility, hypogonadism, erectile dysfunction, and galactorrhea}} | {{Family tree | | | | A01 | | | |A01= Suggestive symptoms including headache, oligomenorrhea, infertility, hypogonadism, erectile dysfunction, and galactorrhea}} | ||
| Line 65: | Line 66: | ||
{{Family tree/end}} | {{Family tree/end}} | ||
===Do's=== | ===Do's=== | ||
* “Hook effect” should be kept in consideration while assessing serum prolactin levels. Patients with macroadenoma can have artifactually low values of serum prolactin between 20 to 200 mcg/L in patients with high levels of serum prolactin i.e. 5000 mcg/L. | * “Hook effect” should be kept in consideration while assessing serum [[prolactin]] levels. Patients with macroadenoma can have artifactually low values of serum [[prolactin]] between 20 to 200 mcg/L in patients with high levels of serum [[prolactin]] i.e. 5000 mcg/L. This artifact is avoided by repeating the assay by dilution of serum. <ref name="pmid21296991">{{cite journal| author=Melmed S, Casanueva FF, Hoffman AR, Kleinberg DL, Montori VM, Schlechte JA | display-authors=etal| title=Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline. | journal=J Clin Endocrinol Metab | year= 2011 | volume= 96 | issue= 2 | pages= 273-88 | pmid=21296991 | doi=10.1210/jc.2010-1692 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21296991 }} </ref> | ||
* Patients with hyperprolactinemia with normal serum prolactin levels should be monitored for regular intervals after discontinuing cabergoline. There is a recurrence of hyperprolactinemia in these patients. | * Patients with [[hyperprolactinemia]] with normal serum [[prolactin]] levels should be monitored for regular intervals after discontinuing [[cabergoline]]. There is a recurrence of [[hyperprolactinemia]] in these patients. | ||
===Don'ts=== | ===Don'ts=== | ||
* Certain medications like risperidone, domperidone, methyldopa, metoclopramide, verapamil, and cimetidine raise serum prolactin levels. These medications can blunt the effects of dopamine agonists. | * Certain medications like [[risperidone]], [[domperidone]], [[methyldopa]], metoclopramide, verapamil, and cimetidine raise serum prolactin levels. These medications can blunt the effects of dopamine agonists. | ||
* The patients should be monitored for side effects. Cabergoline treatment in prolactinoma patients for more than three months can result in impulse control disorders. Hypersexuality is common in males and compulsive eating disorders in females. | * The patients should be monitored for side effects. Cabergoline treatment in prolactinoma patients for more than three months can result in impulse control disorders. Hypersexuality is common in males and compulsive eating disorders in females. | ||
==References== | ==References== | ||
{{Reflist}} | {{Reflist}} | ||
<references /> | |||
Revision as of 07:48, 10 August 2020
Associate Editor(s)-in-Chief: Mydah Sajid, MD[1]
Hyperprolactinemia resident survival guide
Overview
This section provides a short and straight to the point overview of the hyperprolactinemia.
Causes
Life-threatening Causes
Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.
- Severe burns on the chest can cause hyperprolactinemia due to neural stimulation similar to suckling.
Common Causes
- Pregnancy
- Lactation
- Prolactinoma
- Injury to dopaminergic neurons in the hypothalamus (sarcoidosis, craniopharyngioma, and metastatic brain carcinoma)
- Section of the hypothalamic-pituitary stalk
- Antipsychotics (risperidone, haloperidol, and phenothiazine)
- Selective serotonin reuptake inhibitors
- Metoclopramide
- Domperidone
- Methyldopa
- Verapamil
- Familial hyperprolactinemia
- Hypothyroidism
- Chronic renal failure
- macroprolactinomas
- Exercise
Evaluation
Shown below is an algorithm summarizing the diagnosis of hyperprolactinemia according to an Endocrine Society Clinical Practice guidelines:
| Suggestive symptoms including headache, oligomenorrhea, infertility, hypogonadism, erectile dysfunction, and galactorrhea | |||||||||||||||||||
| Detailed history and physical examination should be performed to rule out hypothyroidism, chronic renal failure, and the use of medications known to cause hyperprolactinemia. | |||||||||||||||||||
| Serum prolactin measured. The cut-off values of serum prolactin for hyperprolactinemia are greater than 20 ng/ml in men and postmenopausal women and greater than 30ng/ml in premenopausal women. | |||||||||||||||||||
| MRI with the contrast of brain should be performed to rule out any mass in the hypothalamic-pituitary region. | |||||||||||||||||||
| The levels of other pituitary hormones should be evaluated. The following hormone levels should be evaluated: Plasma corticotropins (ACTH), Serum TSH, Insulin-like growth factors, Follicle-stimulating hormone, Luteinizing hormone, Estradiol/ Testosterone | |||||||||||||||||||
Management
The prolactinoma are treated in the following patients[1][2][3]:
| |||||||||||||||||||||||||||||||
| The drug of choice for prolactinoma are dopamine agonists as they decrease prolactin secretion and reduce the size of the prolactinoma.[4][5] Cabergoline is the preferred drug because of its efficacy and lower incidence of nausea and side effects compared to bromocriptine.[6][7] | Transsphenoidal surgery is done in: | ||||||||||||||||||||||||||||||
| The preferred initial dose of cabergoline for microadenoma is 0.25mg twice a week or 0.5mg once a week. The medicine should be given at dinner or bedtime to reduce the incidence of nausea and drowsiness.[2] | |||||||||||||||||||||||||||||||
| Cabergoline is also preferred by women who wish to conceive as it is safe in early pregnancy.[10] Though bromocriptine is also a safe choice with more evidence of reduced events of congenital defects.[11] | |||||||||||||||||||||||||||||||
Do's
- “Hook effect” should be kept in consideration while assessing serum prolactin levels. Patients with macroadenoma can have artifactually low values of serum prolactin between 20 to 200 mcg/L in patients with high levels of serum prolactin i.e. 5000 mcg/L. This artifact is avoided by repeating the assay by dilution of serum. [2]
- Patients with hyperprolactinemia with normal serum prolactin levels should be monitored for regular intervals after discontinuing cabergoline. There is a recurrence of hyperprolactinemia in these patients.
Don'ts
- Certain medications like risperidone, domperidone, methyldopa, metoclopramide, verapamil, and cimetidine raise serum prolactin levels. These medications can blunt the effects of dopamine agonists.
- The patients should be monitored for side effects. Cabergoline treatment in prolactinoma patients for more than three months can result in impulse control disorders. Hypersexuality is common in males and compulsive eating disorders in females.
References
- ↑ Casanueva FF, Molitch ME, Schlechte JA, Abs R, Bonert V, Bronstein MD; et al. (2006). "Guidelines of the Pituitary Society for the diagnosis and management of prolactinomas". Clin Endocrinol (Oxf). 65 (2): 265–73. doi:10.1111/j.1365-2265.2006.02562.x. PMID 16886971.
- ↑ 2.0 2.1 2.2 Melmed S, Casanueva FF, Hoffman AR, Kleinberg DL, Montori VM, Schlechte JA; et al. (2011). "Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline". J Clin Endocrinol Metab. 96 (2): 273–88. doi:10.1210/jc.2010-1692. PMID 21296991.
- ↑ Melmed S (2020). "Pituitary-Tumor Endocrinopathies". N Engl J Med. 382 (10): 937–950. doi:10.1056/NEJMra1810772. PMID 32130815 Check
|pmid=value (help). - ↑ Vance ML, Evans WS, Thorner MO (1984). "Drugs five years later. Bromocriptine". Ann Intern Med. 100 (1): 78–91. doi:10.7326/0003-4819-100-1-78. PMID 6229205.
- ↑ Wang AT, Mullan RJ, Lane MA, Hazem A, Prasad C, Gathaiya NW; et al. (2012). "Treatment of hyperprolactinemia: a systematic review and meta-analysis". Syst Rev. 1: 33. doi:10.1186/2046-4053-1-33. PMC 3483691. PMID 22828169.
- ↑ Webster J, Piscitelli G, Polli A, Ferrari CI, Ismail I, Scanlon MF (1994). "A comparison of cabergoline and bromocriptine in the treatment of hyperprolactinemic amenorrhea. Cabergoline Comparative Study Group". N Engl J Med. 331 (14): 904–9. doi:10.1056/NEJM199410063311403. PMID 7915824.
- ↑ Biller BM, Molitch ME, Vance ML, Cannistraro KB, Davis KR, Simons JA; et al. (1996). "Treatment of prolactin-secreting macroadenomas with the once-weekly dopamine agonist cabergoline". J Clin Endocrinol Metab. 81 (6): 2338–43. doi:10.1210/jcem.81.6.8964874. PMID 8964874.
- ↑ Feigenbaum SL, Downey DE, Wilson CB, Jaffe RB (1996). "Transsphenoidal pituitary resection for preoperative diagnosis of prolactin-secreting pituitary adenoma in women: long term follow-up". J Clin Endocrinol Metab. 81 (5): 1711–9. doi:10.1210/jcem.81.5.8626821. PMID 8626821.
- ↑ Randall RV, Laws ER, Abboud CF, Ebersold MJ, Kao PC, Scheithauer BW (1983). "Transsphenoidal microsurgical treatment of prolactin-producing pituitary adenomas. Results in 100 patients". Mayo Clin Proc. 58 (2): 108–21. PMID 6681646.
- ↑ Ricci E, Parazzini F, Motta T, Ferrari CI, Colao A, Clavenna A; et al. (2002). "Pregnancy outcome after cabergoline treatment in early weeks of gestation". Reprod Toxicol. 16 (6): 791–3. doi:10.1016/s0890-6238(02)00055-2. PMID 12401507.
- ↑ "Reorganized text". JAMA Otolaryngol Head Neck Surg. 141 (5): 428. 2015. doi:10.1001/jamaoto.2015.0540. PMID 25996397.