Prolactin

Raised prolactin

Causes

  • Physiological – pregnancy, lactation, stress post-prandial, post-exercise
  • Prolactin secreting pituitary tumour – prolactinoma
  • Non-secreting pituitary tumour that prevents dopamine from reaching normal prolactin-producing cells
  • Hypothyroidism
  • Stress
  • Renal failure
  • Liver disease
  • Head injuries
  • Medications – antipsychotics, antiemetics, COCP, antidepressants, verapamil, opiates, cimetidine, cocaine

 

Data gathering

  • Assess severity
    • Mild elevation may be physiological in aetiology
    • >5000 mu/L  – usually prolactin-secreting pituitary tumour
  • Presentation
    • Galactorrhoea (90% of women)
    • Menstrual disturbance
    • Reduced fertility
    • Reduced libido
    • Mass effects – visual-field defects, headache
    • Increased risk of osteoporosis
  • Investigations
    • Examine – visual fields
    • Bloods – prolactin, U+Es, LFTs, TFTs
    • MRI pituitary (after endocrine review)

 

Clinical management

  • Medication review
  • Endocrine referral – MRI pituitary, dopamine agonists (cabergoline, bromocriptine), consideration of transphenoidal surgery