Hypeprolactinemia: still an insidious diagnosis
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E N D O CR I N E M E T H O D S A N D T E C H N I Q U E S
Hypeprolactinemia: still an insidious diagnosis Ludovica Aliberti1 Irene Gagliardi1 Romolo M. Dorizzi2 Stefano Pizzicotti3 Marta Bondanelli Maria Chiara Zatelli 1 Maria Rosaria Ambrosio 1 ●
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Received: 16 July 2020 / Accepted: 7 September 2020 © The Author(s) 2020
Abstract Hyperprolactinemia can have different causes: physiological, pharmacological, and pathological. When investigating the etiology of hyperprolactinemia, clinicians need to be aware of several conditions leading to misdiagnosis. The most popular pitfalls are: acute physical and psychological stress, macroprolactin, hook effect, even though antibodies interferences and biotine use have to be considered. A 52-year-old woman was referred to Endocrinology clinic for oligomenorrhoea and headache. She worked as a butcher. Hormonal evaluation showed very high PRL (305 ng/ml, reference interval: 20 ng/ ml in men and 25 ng/ml in women) [1–3] can have different causes, physiological, pharmacological, and pathological (Table 1). The predominant physiological consequence of hyperprolactinemia is hypogonadotropic hypogonadism due
* Maria Rosaria Ambrosio [email protected] 1
Department of Medical Sciences, Section of Endocrinology and Internal Medicine, University of Ferrara, Ferrara, Italy
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Clinical Pathology Unit, Hub Laboratory, Greater Area, Cesena, Italy
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Laboratory Division of the S. Anna Hospital, University of Ferrara, Ferrara, Italy
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to the suppression of GnRH pulsatility. Clinical manifestations vary according to age and sex of the patient and to the magnitude of PRL secretion increase. Clinical presentation in women with oligomenorrhea, amenorrhea, galactorrhea, decreased libido, infertility, and decreased bone mass is generally more clear and occurs earlier than in men [1–9]. The most common symptoms in men are erectile dysfunction, decreased libido, infertility, gynecomastia, decreased bone mass, while galactorrhea is rare [1–9]. Prolactinomas, that account for 25–30% of functioning pituitary tumors, are the most frequent cause of high PRL [1–9]. Prolactinomas can be microadenomas, more common in premenopausal women, and macroadenomas, more common in men and postmenopausal women [1–9]. Increased PRL concentration can also be induced by pituitary adenomas co-secreting GH and PRL and by sellar/ parasellar masses causing stalk effect, as non-secreting adenomas [1–9]. When investigating the etiology of hyperprolactinemia, clinicians need to be aware of several
Endocrine Table 1 Main causes of hyperprolactinemia
Physiological
Pregnancy, breastfeeding, nipple stimulation, exercise, acute stress, venipuncture.
Pathological
Pituitary: prolactinoma, co-secreting GH-PRL adenoma, non-secreting adenoma, stalk effect from sellar/parasellar mass, empty sella, lymphocitic hyopophysitis, Rahtke’s cyst, irradiation, infiltrative disorders, head trauma. Systemic disease: renal failure, primary hypothyroidism, PCOS, cirrhosis, chest lesions.
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