Prolactin disorders. (August 2021)

• Record Type: Journal Article
• Authors: Martin, Niamh
• Is Part Of: Medicine. Volume 49:Number 8(2021)
• Page Start: 492
• Page End: 494
• Publication Date: 2021-08
• Subjects: Bromocriptine -- cabergoline -- dopamine agonist -- hyperprolactinaemia -- MRCP -- prolactin -- prolactinoma; Medicine -- Periodicals; Medicine -- Periodicals; Médecine -- Périodiques; Médecine factuelle -- Périodiques; Medicine; Periodicals; Electronic journals; Electronic journals; 610
• DOI: 10.1016/j.mpmed.2021.05.008
• Languages: English
• ISSNs: 1357-3039

Abstract

Abstract: Hyperprolactinaemia can be physiological, pathological or drug induced. Elevated serum prolactin concentration can cause secondary hypogonadism via inhibition of hypothalamic gonadotropin-releasing hormone and pituitary gonadotropins. Therefore, it is important to determine pathological causes of hyperprolactinaemia, particularly prolactinoma. Female patients can present with galactorrhoea, menstrual irregularity and infertility, whereas men can present with symptoms of secondary hypogonadism. Macroprolactin, representing <5% of circulating prolactin, is a polymeric form of prolactin with limited bioavailability and bioactivity. In patients with a raised prolactin concentration who lack typical features of hyperprolactinaemia, macroprolactinaemia should be suspected and sought. After confirmation of an elevated serum prolactin and exclusion of other physiological and pathological causes, pituitary magnetic resonance imaging should be performed to investigate the presence of a prolactinoma or non-prolactinoma pituitary tumour. Bromocriptine and cabergoline are the two dopamine agonists used most commonly to correct abnormal serum prolactin concentrations. Both cause tumour shrinkage in prolactinomas and restore gonadal function and fertility, but cabergoline is preferred as it is more effective and better tolerated. Although there are more safety data for bromocriptine than cabergoline, both are considered to be safe in pregnancy.