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Hyperprolactine MIA: Prepared By: Daryl S. Abraham

Hyperprolactinemia is a condition caused by excess prolactin hormone levels. It can be caused by pregnancy, pituitary tumors in around 50% of cases, certain medications, liver disease, infections, or trauma. Symptoms vary between males and females and include issues like infertility, irregular periods, lactation, and sexual dysfunction. Treatment focuses on returning prolactin levels to normal through medication, radiation, or surgery to remove tumors. The case presented was of a woman with a history of genetic conditions and hyperprolactinemia who was being treated with cabergoline.

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117 views15 pages

Hyperprolactine MIA: Prepared By: Daryl S. Abraham

Hyperprolactinemia is a condition caused by excess prolactin hormone levels. It can be caused by pregnancy, pituitary tumors in around 50% of cases, certain medications, liver disease, infections, or trauma. Symptoms vary between males and females and include issues like infertility, irregular periods, lactation, and sexual dysfunction. Treatment focuses on returning prolactin levels to normal through medication, radiation, or surgery to remove tumors. The case presented was of a woman with a history of genetic conditions and hyperprolactinemia who was being treated with cabergoline.

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Biway Regala
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HYPERPROLACTINE

MIA
PREPARED BY: DARYL S. ABRAHAM
Definition

 Prolactin is a hormone produced from the pituitary gland. It helps


stimulate and maintain breast milk production. Hyperprolactinemia
describes an excess of this hormone in a person’s body.
 It’s normal to have this condition during pregnancy or when
producing milk for breastfeeding.
 Certain conditions or use of specific medications, however, can
cause hyperprolactinemia in anyone. The causes and effects of high
prolactin levels vary depending on a person’s sex.
Hyperprolactinemia causes

 An increased level of prolactin may be caused by a variety of


secondary conditions. Most often, hyperprolactinemia is caused by
pregnancy — which is normal.

 According to a 2013 studyTrusted Source, pituitary tumors may be


the cause of almost 50 percent of hyperprolactinemia. A
prolactinoma is a tumor that forms in the pituitary gland. These
tumors are typically noncancerous. But they can cause symptoms
that are different for depending on a person’s sex.
Other causes of hyperprolactinemia
include:
 acid H2 blockers, such as cimetidine (Tagamet)
 antihypertensive medications, such as verapamil (Calan, Isoptin, and Verelan)
 estrogen
 antidepressant drugs such as desipramine (Norpramin) and clomipramine
(Anafranil)
 cirrhosis, or severe scarring of the liver
 Cushing syndrome, which can result from high levels of the hormone cortisol
 infection, tumor, or trauma of the hypothalamus
 anti-nausea medication such as metoclopramide (Primperan, Reglan)
Symptoms of hyperprolactinemia

 Symptoms of hyperprolactinemia can differ in men and women.

 Since prolactin levels affect milk production and menstrual cycles, it


can be difficult to detect in men. If a man is experiencing erectile
dysfunction, their doctor may recommend a blood test to look for
excess prolactin.
Symptoms in females:

 infertility
 irregular periods
 change in menstrual flow
 pause in menstrual cycle
 loss of libido
 lactation (galactorrhea)
 pain in breasts
 vaginal dryness
Symptoms in males:

 abnormal breast growth (gynecomastia)


 lactation
 infertility
 erectile dysfunction
 loss of sexual desire
 headaches
 vision change
CASE PRESENTATION

 A 32 year old woman came to our clinic for the evaluation of


amenorrhea and hyperprolactinemia. She was diagnosed with MGS
at the age of 3 and at the age of 17 she was diagnosed with
hyperprolactinemia and GH deficiency causing her to have a short
stature (4ft 1 inch). She had no family history of similar or related
issues. She was treated with GH replacement in the past, which led
to an increase in her height (5ft) and she received oral
contraceptives until the age of 28. Due to hyperprolactinemia and
anovulatory cycles, she was treated with cabergoline. At the age of
31, she delivered a healthy baby via in vitro fertilization.
 Her most recent physical and vital parameters were under
normal limits (blood pressure: 110/70 mmHg; pulse: 72
per minute; height: five feet; weight: 126 pounds). Visual
acuity to finger counting was 20/20 in the right eye and
20/200 in the left eye. She had hypertelorism and
strabismus of the left eye.
 Laboratory investigations revealed: fasting glucose levels: 87 mg/dl
(65–99); Prolactin: 62 mg/l (2–14); GH: 0.2 ng/ml (0.0–10.0); GH
arginine stimulation test: <2ng/ml; Insulin-like growth factor 1:
22ng/ml (71–241); luteinizing hormone: 1.3 miu/ml (0.0–4.0);
follicle stimulating hormone: 5.0 miu/ml (0.0–5.0); Estradiol: 8.6
pg/ml (12.5–166.0); Dehydroepiandrosterone: 323 ng/dl (31–701);
adrenocorticotropic hormone: 33.1 pg/ml (7.2–63.3); thyroid
stimulating hormone: 1.48 mIU/L (0.45–4.5); free T4: 1.2 ng/dl
(0.58–1.6).
 Magnetic resonance imaging (MRI) performed at this time revealed
an abnormality involving the optic chiasm, left optic nerve and mild
compression of the pituitary gland by a basal encephalocele (BE),
with a normal sized pituitary gland. Genetic studies were positive
for a mutation in Paired box 6 gene (PAX6). She continues to
receive 0.5 mg of cabergoline once daily in view of her elevated
prolactin levels. Our patient does not have any other symptoms and
is being followed up regularly at our clinic.
Treatment

 Treatment of hyperprolactinemia is mostly focused on


returning prolactin levels to normal. In the case of a tumor,
surgery may be needed to remove the prolactinoma, but
the condition can often be managed with medication.
Treatment may involve:

 radiation
 synthetic thyroid hormones
 change of medication
 medication to reduce prolactin, such as bromocriptine
(Parlodel, Cycloset) or cabergoline
Takeaway

 Typically,hyperprolactinemia is treatable. Treatment will


depend on what’s causing excess prolactin secretion. If
you have a tumor, you may need surgery to remove the
tumor and return your pituitary gland to normal.

 Ifyou’re experiencing irregular lactation, erectile


dysfunction, or loss of sexual desire, notify your doctor of
your symptoms so they can perform the necessary tests to
determine the cause
THANK YOU

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