Physiological and Pathological Hyperprolactinemia: Can We Minimize Errors in the Clinical Practice?

López, Miguel Ángel Castaño; Rodríguez, José Luis; García, Marta Robles

doi:10.5772/54758

Cited by 5 publications

(6 citation statements)

References 21 publications

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“…One study documented a transient rise of prolactin in females during their mid-cycle; the rate rises to 94% in those with infertility, ranging between 25–75 ng/mL and usually lasting 1–3 days 19. Additionally, prolactin follows a circadian rhythm with the highest reading occurring during sleep and immediately after awakening 12. It also increases after sexual intercourse, following a protein-rich meal and during stress 12.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, prolactin follows a circadian rhythm with the highest reading occurring during sleep and immediately after awakening 12. It also increases after sexual intercourse, following a protein-rich meal and during stress 12. Whyte et al .…”

Section: Discussionmentioning

confidence: 99%

“…Prolactinomas were classified as macroprolactinomas (≥1 cm) or microprolactinomas (<1 cm) based on the size of the tumours. Prolactin levels <200 ng/mL (off-treatment) in patients with a sellar mass >1 cm were considered to be suggestive of the stalk effect 12. PCOS was accepted as the cause of hyperprolactinaemia if a diagnosis was documented by an experienced gynaecologist or endocrinologist.…”

Section: Methodsmentioning

confidence: 99%

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Aetiologies of Hyperprolactinaemia: A retrospective analysis from a tertiary healthcare centre

Malik

Aziz

Beshyah

et al. 2019

Sultan Qaboos Univ Med J

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Objectives: This study aimed to evaluate the aetiologies of hyperprolactinaemia in the United Arab Emirates (UAE). Methods: This retrospective study used laboratory databases to identify all patients who underwent evaluation for prolactin at Tawam Hospital, Al Ain, UAE, between 2009 and 2015. Of those 2,280 patients, all patients with low or normal prolactin (n = 1,315) were excluded. Subsequently, charts of the remaining patients (n= 965) with hyperprolactinaemia were reviewed and those with incomplete work-ups or insufficient documentation of the hyperprolactinaemia’s aetiology were excluded (n = 458). Results: A total of 507 patients were included in the study. The average age at prolactin evaluation was 36 ± 13.2 years and the majority (67.1%) of patients were female. The most common reasons for requesting prolactin were menstrual disorders (29.5%), infertility (18%),evaluation of sellar masses (14.3%), ruling out seizures (13.4 %) and monitoring while on psychiatric medications (8.7%). The most common causes of hyperprolactinaemia were prolactinoma (17%), transient hyperprolactinaemia(14.6%), drug-induced side effects (14.4%), polycystic ovarian syndrome (11.8%) and seizure disorder (7.7%). In females, common aetiologies were prolactinomas, transient and idiopathic hyperprolactinaemia, while sellar masses, seizures, chronic kidney disease and acute illnesses were common aetiologies of hyperprolactinaemia in males. The prolactin level varied between the different aetiologies and a level of >250 ng/mL was suggestive of macroprolactinoma. Conclusion: A significant proportion of patients with hyperprolactinaemia have transient hyperprolactinaemia. Before further investigations are carried out, prolactin level assessment should be repeated, especially in patients with mild hyperprolactinaemia.Keywords: Hyperprolactinemia; Prolactinoma; Etiology; Epidemiology; United Arab Emirates.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Aetiologies of Hyperprolactinaemia: A retrospective analysis from a tertiary healthcare centre

Malik

Aziz

Beshyah

et al. 2019

Sultan Qaboos Univ Med J

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“…1,14 Sampai saat ini, sebagian besar penelitian menggunakan batas kadar prolaktin ≥200 ng/ mL sebagai parameter untuk menegakkan diagnosis prolaktinoma. 2,[14][15][16] Pasien kami mengalami hilangnya penglihatan mata kanan disertai nyeri kepala kronis ketika masuk rumah sakit. Selain itu, pasien juga mengalami hiperprolaktinemia 198,10 ng/mL (nilai referensi 2,1-17,1 ng/mL) 12,15,17 Pada pasien ini, pemeriksaan prolaktin dengan dilusi 1:100 tidak dilakukan.…”

Section: Pembahasanunclassified

“…2,[14][15][16] Pasien kami mengalami hilangnya penglihatan mata kanan disertai nyeri kepala kronis ketika masuk rumah sakit. Selain itu, pasien juga mengalami hiperprolaktinemia 198,10 ng/mL (nilai referensi 2,1-17,1 ng/mL) 12,15,17 Pada pasien ini, pemeriksaan prolaktin dengan dilusi 1:100 tidak dilakukan. Modalitas terapi untuk makroadenoma hipofisis dengan hiperprolaktinemia terdiri dari terapi farmakologi dengan agonis dopamin seperti bromokriptin dan kabergolin, operasi EETA, serta radioterapi.…”

Section: Pembahasanunclassified

Laporan Kasus: Perbaikan Kadar Prolaktin pada Makroadenoma Hipofisis dengan Terapi Bromokriptin dan EETA

Gayatri

Hidayati

2020

ijcp

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Hiperprolaktinemia merupakan salah satu gejala klinis yang umum terjadi pada kasus makroadenoma hipofisis. Hiperprolaktinemia yang terjadi pada makroadenoma hipofisis dapat disebabkan oleh adanya penekanan massa tumor terhadap infundibulum (pituitary stalk) atau adanya sekresi hormon oleh tumor. Penelitian ini bertujuan untuk membahas pengaruh pemberian terapi bromokriptin dan operasi Endoscopic Endonasal Transsphenoidal Approach (EETA) terhadap perbaikan kadar hormon prolaktin dan kondisi klinis pada kasus makroadenoma hipofisis dengan hiperprolaktinemia. Dalam laporan kasus ini, dilaporkan bahwa seorang remaja pria usia 17 tahun datang dengan hilangnya penglihatan mata kanan, nyeri kepala, sulit menelan, dan ginekomasti. Pemeriksaan Magnetic Resonance Imaging (MRI) otak dengan kontras didapatkan adanya lesi ekstra aksial supratentorial di intrasellar yang meluas hingga suprasellar. Pada pemeriksaan laboratorium didapatkan adanya hiperprolaktinemia 198,10 ng/mL (nilai referensi 2,1-17,1 ng/mL). Hiperprolaktinemia yang terjadi pada kasus ini dapat disebabkan oleh tumor hipofisis yang mensekresi prolaktin (prolaktinoma) dan/atau akibat dari pendesakan massa tumor terhadap infundibulum. Berdasarkan hasil anamnesis, pemeriksaan fisik, pemeriksaan laboratorium dan penunjang, pasien didiagnosis mengalami makroadenoma hipofisis. Kami mempresentasikan kasus perbaikan kondisi klinis dan total penurunan kadar prolaktin sebesar 79,70% (pre pengobatan 198,10 ng/mL, post pengobatan 40,20 ng/mL) pada pasien dengan makroadenoma hipofisis yang disertai hiperprolaktinemia setelah dilakukan pemberian terapi bromokriptin 2,5 mg per hari selama 14 hari masa perawatan di rumah sakit dan tindakan operasi EETA.

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“This Is Not the Original Timeline”: A Case Report of an Extended Dissociative Episode in a Healthy Young Male Accompanied with Severe Decline in Mental State

Tong

Groom

Ward

et al. 2021

Case Reports in Psychiatry

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Dissociation is a disconnection between a person’s thoughts, memories, feelings, actions, or sense of who he or she is. Dissociative disorders can be described and understood using the combination of five core symptoms: amnesia, depersonalisation, derealisation, identity confusion, or identity alteration. They are frequently associated with previous experience of trauma. The challenge in diagnosis and the lifetime prevalence of approximately 10% in the general population and clinical psychiatric setting ensures the relevance of this case. We write about a 21-year-old gentleman with history of autism and obsessive compulsive disorder, but no significant medical history was presented to the emergency department with increased anxiety, subsequently progressing to agitation, pacing, and becoming nonverbal. No significant findings were uncovered on laboratory blood testing (other than prolactin 737 mu/L and phosphate 0.35 mmol/L), lumbar puncture, or brain imaging. Consequently, he was admitted to a psychiatric unit for assessment. The patient continued to present with severe disorientation, limited speech, and altered state of consciousness with occasional spastic-like movements. Antipsychotic and benzodiazepine medication was initiated, with no significant change in presentation. The patient continued to be witnessed wandering and having incoherent speech. First signs of improvement came 21 days postadmission with brief conversation and lucidity. This continued to improve over the next 7 days where he was reported to be at his baseline mental state. Environmental stressors including university examinations, the COVID-19 pandemic, and recent contact with his estranged father were possible precipitants to the episode. The patient reported almost complete unawareness of the psychiatric admission. A diagnosis of dissociative disorder, unspecified, was given. This case shows the management and diagnostic challenges of patients presenting with the aforementioned symptoms. There are no formal guidelines for the management of treating dissociative episodes, and this case report suggests the possible benefits of a drug-free period of watchful waiting upon admission.

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Physiological and Pathological Hyperprolactinemia: Can We Minimize Errors in the Clinical Practice?

Cited by 5 publications

References 21 publications

Aetiologies of Hyperprolactinaemia: A retrospective analysis from a tertiary healthcare centre

Aetiologies of Hyperprolactinaemia: A retrospective analysis from a tertiary healthcare centre

Laporan Kasus: Perbaikan Kadar Prolaktin pada Makroadenoma Hipofisis dengan Terapi Bromokriptin dan EETA

“This Is Not the Original Timeline”: A Case Report of an Extended Dissociative Episode in a Healthy Young Male Accompanied with Severe Decline in Mental State

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