|
|
| Line 1: |
Line 1: |
| __NOTOC__ | | __NOTOC__ |
| {{AE}} {{MSJ}} | | {{AE}} {{MSJ}} |
| ==Hyperprolactinemia resident survival guide== | | ==Sore throat in adults resident survival guide== |
| ===Overview=== | | ===Overview=== |
| [[Hyperprolactinemia]] is defined as high circulating levels of [[prolactin]] in the blood. 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.<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> [[Prolactin]] [[hormone]] is produced by lactotroph cells located in the anterior lobe of the [[pituitary gland]]. It is responsible for [[lactation]] and the development of [[breasts]] in females during pregnancy. Elevated levels of [[prolactin]] cause [[galactorrhea]], menstrual irregularities, and failure to conceive in females and erectile dysfunction, [[hypogonadism]], and [[infertility]] in males. 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 [[Burn|burns]] on the chest can cause [[hyperprolactinemia]] due to neural stimulation similar to suckling<ref name="pmid562902">{{cite journal| author=Morley JE, Dawson M, Hodgkinson H, Kalk WJ| title=Galactorrhea and hyperprolactinemia associated with chest wall injury. | journal=J Clin Endocrinol Metab | year= 1977 | volume= 45 | issue= 5 | pages= 931-5 | pmid=562902 | doi=10.1210/jcem-45-5-931 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=562902 }} </ref>.
| |
|
| |
| ====Common Causes==== | | ====Common Causes==== |
| *[[Pregnancy]]<ref name="pmid5024994">{{cite journal| author=Tyson JE, Hwang P, Guyda H, Friesen HG| title=Studies of prolactin secretion in human pregnancy. | journal=Am J Obstet Gynecol | year= 1972 | volume= 113 | issue= 1 | pages= 14-20 | pmid=5024994 | doi=10.1016/0002-9378(72)90446-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5024994 }} </ref> | | * Viral upper respiratory tract infection (Adenovirus, rhinovirus, coronavirus, enterovirus, influenza A and B, parainfluenza virus, respiratory syncytial virus, and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). <ref name="pmid2494921">{{cite journal| author=Huovinen P, Lahtonen R, Ziegler T, Meurman O, Hakkarainen K, Miettinen A | display-authors=etal| title=Pharyngitis in adults: the presence and coexistence of viruses and bacterial organisms. | journal=Ann Intern Med | year= 1989 | volume= 110 | issue= 8 | pages= 612-6 | pmid=2494921 | doi=10.7326/0003-4819-110-8-612 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2494921 }} </ref><ref name="pmid11172144">{{cite journal| author=Bisno AL| title=Acute pharyngitis. | journal=N Engl J Med | year= 2001 | volume= 344 | issue= 3 | pages= 205-11 | pmid=11172144 | doi=10.1056/NEJM200101183440308 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11172144 }} </ref> |
| *[[Lactation]]<ref name="pmid5024994">{{cite journal| author=Tyson JE, Hwang P, Guyda H, Friesen HG| title=Studies of prolactin secretion in human pregnancy. | journal=Am J Obstet Gynecol | year= 1972 | volume= 113 | issue= 1 | pages= 14-20 | pmid=5024994 | doi=10.1016/0002-9378(72)90446-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5024994 }} </ref>
| |
| *[[Prolactinoma]]<ref name="pmid840242">{{cite journal| author=Kleinberg DL, Noel GL, Frantz AG| title=Galactorrhea: a study of 235 cases, including 48 with pituitary tumors. | journal=N Engl J Med | year= 1977 | volume= 296 | issue= 11 | pages= 589-600 | pmid=840242 | doi=10.1056/NEJM197703172961103 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=840242 }} </ref>
| |
| * Injury to dopaminergic neurons in the hypothalamus ([[sarcoidosis]], [[craniopharyngioma]], and metastatic brain carcinoma)<ref name="pmid840242">{{cite journal| author=Kleinberg DL, Noel GL, Frantz AG| title=Galactorrhea: a study of 235 cases, including 48 with pituitary tumors. | journal=N Engl J Med | year= 1977 | volume= 296 | issue= 11 | pages= 589-600 | pmid=840242 | doi=10.1056/NEJM197703172961103 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=840242 }} </ref>
| |
| * Section of the hypothalamic-pituitary stalk
| |
| * Antipsychotics ([[risperidone]], [[haloperidol]], and [[phenothiazine]])<ref name="pmid11048906">{{cite journal| author=David SR, Taylor CC, Kinon BJ, Breier A| title=The effects of olanzapine, risperidone, and haloperidol on plasma prolactin levels in patients with schizophrenia. | journal=Clin Ther | year= 2000 | volume= 22 | issue= 9 | pages= 1085-96 | pmid=11048906 | doi=10.1016/S0149-2918(00)80086-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11048906 }} </ref>
| |
| * Selective serotonin reuptake inhibitors
| |
| *[[Metoclopramide]]<ref name="pmid777023">{{cite journal| author=McCallum RW, Sowers JR, Hershman JM, Sturdevant RA| title=Metoclopramide stimulates prolactin secretion in man. | journal=J Clin Endocrinol Metab | year= 1976 | volume= 42 | issue= 6 | pages= 1148-52 | pmid=777023 | doi=10.1210/jcem-42-6-1148 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=777023 }} </ref>
| |
| *[[Domperidone]]<ref name="pmid7037817">{{cite journal| author=Sowers JR, Sharp B, McCallum RW| title=Effect of domperidone, an extracerebral inhibitor of dopamine receptors, on thyrotropin, prolactin, renin, aldosterone, and 18-hydroxycorticosterone secretion in man. | journal=J Clin Endocrinol Metab | year= 1982 | volume= 54 | issue= 4 | pages= 869-71 | pmid=7037817 | doi=10.1210/jcem-54-4-869 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7037817 }} </ref>
| |
| *[[Methyldopa]]<ref name="pmid1268617">{{cite journal| author=Steiner J, Cassar J, Mashiter K, Dawes I, Fraser TR, Breckenridge A| title=Effects of methyldopa on prolactin and growth hormone. | journal=Br Med J | year= 1976 | volume= 1 | issue= 6019 | pages= 1186-8 | pmid=1268617 | doi=10.1136/bmj.1.6019.1186 | pmc=1639736 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1268617 }} </ref>
| |
| *[[Verapamil]]
| |
| * Familial [[hyperprolactinemia]]<ref name="pmid24195502">{{cite journal| author=Newey PJ, Gorvin CM, Cleland SJ, Willberg CB, Bridge M, Azharuddin M | display-authors=etal| title=Mutant prolactin receptor and familial hyperprolactinemia. | journal=N Engl J Med | year= 2013 | volume= 369 | issue= 21 | pages= 2012-2020 | pmid=24195502 | doi=10.1056/NEJMoa1307557 | pmc=4209110 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24195502 }} </ref>
| |
| *[[Hypothyroidism]]<ref name="pmid4199418">{{cite journal| author=Snyder PJ, Jacobs LS, Utiger RD, Daughaday WH| title=Thyroid hormone inhibition of the prolactin response to thyrotropin-releasing hormone. | journal=J Clin Invest | year= 1973 | volume= 52 | issue= 9 | pages= 2324-9 | pmid=4199418 | doi=10.1172/JCI107421 | pmc=333037 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4199418 }} </ref>
| |
| *[[Chronic renal failure]]
| |
| * macroprolactinomas
| |
| *[[Physical exercise|Exercise]]
| |
| | |
| ===Evaluation===
| |
| Shown below is an algorithm summarizing the diagnosis of [[hyperprolactinemia]] according to an Endocrine Society Clinical Practice guidelines<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><ref name="pmid24347930">{{cite journal| author=Majumdar A, Mangal NS| title=Hyperprolactinemia. | journal=J Hum Reprod Sci | year= 2013 | volume= 6 | issue= 3 | pages= 168-75 | pmid=24347930 | doi=10.4103/0974-1208.121400 | pmc=3853872 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24347930 }} </ref>:
| |
| {{Family tree/start}}
| |
| {{Family tree | | | | A01 | | | |A01= Characterize the symptoms
| |
| * headache
| |
| * oligomenorrhea
| |
| * infertility
| |
| * hypogonadism
| |
| * erectile dysfunction
| |
| * galactorrhea}}
| |
| {{Family tree | | | | |!| | | | | }}
| |
| {{Family tree | | | | |!| | | | | }}
| |
| {{Family tree | | | | |!| | | | | }}
| |
| {{Family tree | | | | B01 | | | |B01= Inquire about any present illness like hypothyroidism, chronic renal failure, and the use of medications known to cause hyperprolactinemia.}}
| |
| {{Family tree | | | | |!| | | | | }}
| |
| {{Family tree | | | | |!| | | | | }}
| |
| {{Family tree | | | | |!| | | | | }}
| |
| {{Family tree | | | | C01 | | | |C01= Measure serum prolactin. Elevated serum prolactin }}
| |
| {{Family tree | | | | |!| | | | | }}
| |
| {{Family tree | | | | |!| | | | | }}
| |
| {{Family tree | | | | |!| | | | | }}
| |
| {{Family tree | | | | D01 | | | |D01= Mesure serum TSH. TSH levels elevated?}}
| |
| {{familytree | | |,|-|^|-|.| }}
| |
| {{familytree | | E01 | | |E02|E01= Yes | E02= No}}
| |
| {{familytree | | |!| | | |!| }}
| |
| {{familytree | | F01 | | |F02|F01= Treat hypothyroidism | F02= Perform the MRI with the contrast of the brain. Does it show any mass in the hypothalamic-pituitary region? }}
| |
| {{familytree | | |!| | |,|-|^|-|.| }}
| |
| {{familytree | | G01 | |G02 | | G03 |G01= Levels of TSH and prolactin should be reassessed after 6-12 weeks. | G02=Yes. The levels of other pituitary hormones should be evaluated: Plasma corticotropins (ACTH), Serum TSH, Insulin-like growth factors, Follicle-stimulating hormone, Luteinizing hormone, Estradiol/ Testosterone | G03= No}}
| |
| {{Family tree/end}}
| |
| | |
| ===Management===
| |
| Shown below is an algorithm summarizing the treatment of [[hyperprolactinemia]]<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><ref name="pmid16886971">{{cite journal| author=Casanueva FF, Molitch ME, Schlechte JA, Abs R, Bonert V, Bronstein MD | display-authors=etal| title=Guidelines of the Pituitary Society for the diagnosis and management of prolactinomas. | journal=Clin Endocrinol (Oxf) | year= 2006 | volume= 65 | issue= 2 | pages= 265-73 | pmid=16886971 | doi=10.1111/j.1365-2265.2006.02562.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16886971 }} </ref><ref name="pmid7915824">{{cite journal| author=Webster J, Piscitelli G, Polli A, Ferrari CI, Ismail I, Scanlon MF| title=A comparison of cabergoline and bromocriptine in the treatment of hyperprolactinemic amenorrhea. Cabergoline Comparative Study Group. | journal=N Engl J Med | year= 1994 | volume= 331 | issue= 14 | pages= 904-9 | pmid=7915824 | doi=10.1056/NEJM199410063311403 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7915824 }} </ref><ref name="pmid6681646">{{cite journal| author=Randall RV, Laws ER, Abboud CF, Ebersold MJ, Kao PC, Scheithauer BW| title=Transsphenoidal microsurgical treatment of prolactin-producing pituitary adenomas. Results in 100 patients. | journal=Mayo Clin Proc | year= 1983 | volume= 58 | issue= 2 | pages= 108-21 | pmid=6681646 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6681646 }} </ref>:
| |
| {{Family tree/start}}
| |
| {{Family tree | | | | A01 | | | |A01= The prolactinoma are treated in the following patients:
| |
| * A macroadenoma causing neurological symptoms such as headache and visual impairment due to compression of the optic chiasm.
| |
| * Hypogonadism and galactorrhea due to increased prolactin secretion.
| |
| * Infertility in women with disrupted luteal phase.
| |
| }}
| |
| {{Family tree | |,|-|-|^|-|-|.| | }}
| |
| {{Family tree | B01 | | | | B02 |B01= The drug of choice for prolactinoma are dopamine agonists as they decrease prolactin secretion and reduce the size of the prolactinoma. Cabergoline is the preferred drug because of its efficacy and lower incidence of nausea and side effects compared to bromocriptine. | B02= Transsphenoidal surgery is done in:
| |
| * Patients with unsuccessful treatment with dopamine agonists.
| |
| * A female patient with a known history of lactotroph macroadenoma who wishes to conceive. }}
| |
| {{familytree | |!| | | | | |!| | | }}
| |
| {{Family tree | C01 | | | |C02| C01= 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. | C02= Transsphenoidal surgery has a high success rate in reducing serum prolactin to a normal level. }}
| |
| {{Family tree/end}}
| |
| | |
| ===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.<ref name="pmid9591215">{{cite journal| author=Petakov MS, Damjanović SS, Nikolić-Durović MM, Dragojlović ZL, Obradović S, Gligorović MS | display-authors=etal| title=Pituitary adenomas secreting large amounts of prolactin may give false low values in immunoradiometric assays. The hook effect. | journal=J Endocrinol Invest | year= 1998 | volume= 21 | issue= 3 | pages= 184-8 | pmid=9591215 | doi=10.1007/BF03347299 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9591215 }} </ref> This artifact is avoided by repeating the assay by dilution of serum.
| |
| * Cabergoline is preferred by women who wish to conceive as it is safe in early pregnancy.<ref name="pmid8829257">{{cite journal| author=Robert E, Musatti L, Piscitelli G, Ferrari CI| title=Pregnancy outcome after treatment with the ergot derivative, cabergoline. | journal=Reprod Toxicol | year= 1996 | volume= 10 | issue= 4 | pages= 333-7 | pmid=8829257 | doi=10.1016/0890-6238(96)00063-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8829257 }} </ref> Though bromocriptine is also a safe choice with more evidence of reduced events of congenital defects.<ref name="pmid7062462">{{cite journal| author=Turkalj I, Braun P, Krupp P| title=Surveillance of bromocriptine in pregnancy. | journal=JAMA | year= 1982 | volume= 247 | issue= 11 | pages= 1589-91 | pmid=7062462 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7062462 }} </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.<ref name="pmid14627787">{{cite journal| author=Colao A, Di Sarno A, Cappabianca P, Di Somma C, Pivonello R, Lombardi G| title=Withdrawal of long-term cabergoline therapy for tumoral and nontumoral hyperprolactinemia. | journal=N Engl J Med | year= 2003 | volume= 349 | issue= 21 | pages= 2023-33 | pmid=14627787 | doi=10.1056/NEJMoa022657 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14627787 }} </ref>
| |
| | |
| ===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.<ref name="pmid30848825">{{cite journal| author=Dogansen SC, Cikrikcili U, Oruk G, Kutbay NO, Tanrikulu S, Hekimsoy Z | display-authors=etal| title=Dopamine Agonist-Induced Impulse Control Disorders in Patients With Prolactinoma: A Cross-Sectional Multicenter Study. | journal=J Clin Endocrinol Metab | year= 2019 | volume= 104 | issue= 7 | pages= 2527-2534 | pmid=30848825 | doi=10.1210/jc.2018-02202 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30848825 }} </ref>
| |
|
| |
|
| ==References== | | ==References== |
| {{Reflist}} | | {{Reflist}} |
| <references /> | | <references /> |