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{{Family tree | | | | C01 | | | |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.<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> }} | {{Family tree | | | | C01 | | | |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.<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> }} | ||
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{{Family tree | | | | D01 | | | |D01= Cabergoline is also preferred by women who wish to conceive as it is safe in early pregnancy.[8] Though bromocriptine is also a safe choice with more evidence of reduced events of congenital defects.<ref name="pmid25996397">{{cite journal| author=| title=Reorganized text. | journal=JAMA Otolaryngol Head Neck Surg | year= 2015 | volume= 141 | issue= 5 | pages= 428 | pmid=25996397 | doi=10.1001/jamaoto.2015.0540 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25996397 }} </ref> }} | |||
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==References== | ==References== | ||
{{Reflist}} | {{Reflist}} |
Revision as of 08:38, 8 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. [1]
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[2]:
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[3][2][4]:
| |||||||||||||||||||
The drug of choice for prolactinoma are dopamine agonists as they decrease prolactin secretion and reduce the size of the prolactinoma.[5][6] Cabergoline is the preferred drug because of its efficacy and lower incidence of nausea and side effects compared to bromocriptine.[7][8] | |||||||||||||||||||
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.[8] Though bromocriptine is also a safe choice with more evidence of reduced events of congenital defects.[9] | |||||||||||||||||||
References
- ↑ Morley JE, Dawson M, Hodgkinson H, Kalk WJ (1977). "Galactorrhea and hyperprolactinemia associated with chest wall injury". J Clin Endocrinol Metab. 45 (5): 931–5. doi:10.1210/jcem-45-5-931. PMID 562902.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ "Reorganized text". JAMA Otolaryngol Head Neck Surg. 141 (5): 428. 2015. doi:10.1001/jamaoto.2015.0540. PMID 25996397.