Prolactinoma differential diagnosis
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Overview
Prolactinoma must be differentiated from other diseases that cause hyperprolactinemia including hypothyroidism and side effects of medications including antipsychotics and antidepressants.
Differential Diagnosis
Prolactinoma must be differentiated from other diseases that cause hyperprolactinemia including:
- Prescription drugs. Prolactin secretion in the pituitary is normally suppressed by the brain chemical dopamine. Drugs that block the effects of dopamine at the pituitary or deplete dopamine stores in the brain may cause the pituitary to secrete prolactin. These drugs include older antipsychotic medications such as trifluoperazine (Stelazine) and haloperidol (Haldol); the newer antipsychotic drugs risperidone (Risperdal) and molindone (Moban); metoclopramide (Reglan), used to treat gastroesophageal reflux and the nausea caused by certain cancer drugs; and less often, verapamil, alpha-methyldopa (Aldochlor, Aldoril), and reserpine (Serpalan, Serpasil), used to control high blood pressure. Some antidepressants may cause hyperprolactinemia, but further research is needed[1].
- Pituitary tumors other than prolactinoma. Other tumors arising in or near the pituitary may block the flow of dopamine from the brain to the prolactin-secreting cells. Such tumors include:
- Somatotroph adenoma: It results in acromegaly, a condition caused by excessive growth hormone
- Corticotroph adenoma: It results in Cushing's syndrome, caused by excessive cortisol.
Other pituitary tumors that do not result in excess hormone production may also block the flow of dopamine.
- Hypothyroidism. Increased prolactin levels are often seen in people with hypothyroidism, a condition in which the thyroid does not produce enough thyroid hormone. Physicians routinely test people with hyperprolactinemia for hypothyroidism.
- Chest involvement. Nipple stimulation also can cause a modest increase in the amount of prolactin in the blood. Similarly, chest wall injury or shingles involving the chest wall may also cause hyperprolactinemia.
- Normal pregnancy.