Endocrine Abstracts

Hyperprolactinaemia is the most common endocrine disorder of the hypothalamic-pituitary axis and represents a significant referral volume to secondary care. It is therefore necessary to employ a timely, structured management pathway.

This retrospective cohort study at University Hospitals Birmingham, included 450 patients with serum hyperprolactinaemia, measured between 2011 and 2012. Patients with a known hyperprolactinaemia were excluded. 71 patients remained for subsequent analysis. Data presented does not include patients with hyperprolactinaemia measured in the community whose prolactins had normalised at time of review.

Of the 71 patients identified 62.0% were female. The most common presenting complaint was either oligomenorrhoea or amenorrhoea (29.6%). Other significant presenting complaints included: galactorrhoea (15.5%); headache (14.1%); visual field defects (8.5%) and erectile dysfunction (7.0%). Patients with persistent hyperprolactinaemia underwent dedicated MRI pituitary.

The predominant aetiology was microprolactinoma (18.3%) (mean prolactin 2118.9) and non-functioning pituitary adenoma (15.5%) (mean prolactin 810.5). Of those with microprolactinoma the majority were managed with cabergoline (50%). Drug induced hyperprolactinaemia accounted for 14.8% of patients (mean prolactin 1352.5); mostly due to risperidone (66.7%). Management of these patients proved difficult given the persistent requirement for the causative drug.

In the secondary care setting at University Hospitals Birmingham the investigation and management of both incidentally and rationally identified hyperprolactinaemia represents a significant service burden. five of the ten patients thought to have drug induced hyperprolactinaemia underwent MRI pituitary and 100% of these scans were normal. It may therefore be worth rationalising the use of imaging in such cases and electing for a change in medication and repeat measurement of prolactin. The exclusion of patients whose community measured hyperprolactinaema had normalised limits cohort number. It also suggests that in cases of incidentally found hyperprolactinaemia with a borderline result repeating this result in the community may prevent referral.