ISSN: 1301-2193 E-ISSN: 1308-9846
  • Turkish Journal of
    Endocrinology and Metabolism
ORIGINAL ARTICLE

Clinical Profile and Changing Etiological Spectrum of Hyperprolactinemia at a Tertiary Care Endocrine Facility
Üçüncü Basamak Bir Endokrin Kuruluşunda Hiperprolaktineminin Klinik Profili ve Değişen Etiyolojik Spektrumu
Received Date : 09 Jul 2020
Accepted Date : 16 Nov 2020
Available Online : 10 Dec 2020
Doi: 10.25179/tjem.2020-77992 - Makale Dili: EN
Turk J Endocrinol Metab. 2020;24:308-313
Bu makale, CC BY-NC-SA altında lisanslanmış açık erişim bir makaledir.
ABSTRACT
Objective: Hyperprolactinemia is the most common disorder of the hypothalamic- pituitary axis. It is most commonly caused by a pituitary adenoma. Due to the recent easy availability of over-the-counter medication, many drugs, including herbals have commonly been related to this disorder. Our purpose was to study the clinical presentation and etiology of hyperprolactinemia and to address any changing trend in the etiological profile of this disorder. Material and Methods: This study was a crosssectional observational study on the etiologic spectrum and clinical profile of hyperprolactinemia. A total of 100 consecutive non-pregnant and non-lactating patients attending or referred to the out-patient department of Endocrinology at SKIMS, Srinagar were included. Hyperprolactinemia was confirmed by a serum prolactin level of >25 ng/mL (normal range=1-20 ng/mL). Patients with suspicion of drug-related hyperprolactinemia were advised to stop drug consumption for a minimum of three days (if medically feasible) and retest for prolactin levels as per the Institutional protocol. Hyperprolactinemia in patients whose prolactin levels normalized after stopping drug consumption was labeled as druginduced hyperprolactinemia. Young patients with pituitary adenoma were evaluated for multiple endocrine neoplasia syndrome (MEN 1). The results were compared with those of a study conducted two decades ago at the same center. Results: Galactorrhea was the most common presenting symptom occurring in 64% of subjects (all females), followed by oligomenorrhea or amenorrhea in 60 patients. Both menstrual abnormalities and galactorrhea were seen in 35 patients. Drug-induced hyperprolactinemia was the most common cause seen in 59 patients, followed by pituitary adenoma seen in 31 patients and idiopathic cause seen in only 4% of cases. However, in the study done two decades ago at the same center, microprolactinoma was the most common cause (35.8%), followed by idiopathic hyperprolactinemia (27.8%), with drugs being responsible in only 5% of the cases. Domperidone and levosulpride constituted about 88% of drug-induced hyperprolactinemia. Microprolactinoma was demonstrated in 15 patients, macroadenoma in 16 patients, hypothyroidism in 4% cases, and only one patient had the polycystic ovarian disease. In four patients, no apparent cause could be determined. Conclusion: In our study, drug-induced hyperprolactinemia was the most frequent identifiable etiology, with prokinetics being the most common cause; contrary to previous studies, where pituitary adenoma followed by neuroleptic drugs was found to be the most common. Discontinuation of the offending drug resolved HP in all the patients.
ÖZET
Amaç: Hiperprolaktinemi, hipotalamus-hipofiz aksının en sık görülen bozukluğudur. En yaygın nedeni ise hipofiz adenomudur. Son zamanlarda reçetesiz satılan ilaçların kolay bulunabilirliği nedeniyle, bitkiler de dahil olmak üzere birçok ilaç bu bozuklukla ilişkilendirilmiştir. Burada, hiperprolaktineminin klinik prezentasyonunun ve etiyolojisinin incelenmesi ve bu bozukluğun etiyolojik profilindeki değişen eğilimlerin ele alınması amaçlanmıştır. Gereç ve Yöntemler: Bu çalışma, hiperprolaktineminin etiyolojik spektrumu ve klinik profili üzerine kesitsel, gözlemsel bir çalışmadır. Srinagar'daki SKIMS endokrinoloji polikliniğine gelen veya bu polikliniğe sevk edilen, gebe olmayan ve emzirmeyen toplam 100 hasta çalışmaya dahil edilmiştir. Hiperprolaktinemi, serum prolaktin seviyesinin >25 ng/mL olması ile doğrulanmıştır (normal aralık=1–20 ng/mL). İlaçla ilişkili hiperprolaktinemi şüphesi olan hastalara, en az üç gün süreyle ilaç kullanmayı bırakmaları (tıbbi olarak uygunsa) ve kurum protokolüne göre prolaktin seviyelerini yeniden test ettirmeleri tavsiye edilmiştir. İlaç kullanmayı bıraktıktan sonra prolaktin seviyeleri normale dönen hastalardaki hiperprolaktinemi, ilaca-bağlı hiperprolaktinemi olarak etiketlenmiştir. Hipofiz adenomlu genç hastalar multipl endokrin neoplazi sendromu (MEN 1) açısından değerlendirilmiştir. Elde edilen sonuçlar, aynı merkezde yirmi yıl önce yapılan bir araştırmanın sonuçlarıyla karşılaştırılmıştır. Bulgular: Galaktore, katılımcıların %64'ünde (tümü kadın) gözlenen en yaygın başvuru semptomuydu. Bunu oligomenore veya amenore izliyordu (60 hasta). 35 hastada hem menstrual anomaliler hem de galaktore görüldü. İlaca bağlı hiperprolaktinemi en sık neden iken (59 hasta), bunu hipofiz adenomu (31 hasta) ve idiyopatik neden (vakaların sadece %4'ü) izlemekteydi. Oysaki, 20 yıl önce aynı merkezde yapılan çalışmada mikroprolaktinoma en sık nedendi (%35,8), bunu idiyopatik hiperprolaktinemi (%27,8) izliyordu ve vakaların sadece %5'inden ilaçlar sorumluydu. Domperidon ve levosulpirid, ilaca bağlı hiperprolaktineminin yaklaşık %88'ini oluşturmaktaydı. 15 hastada mikroprolaktinoma, 16 hastada makroadenom, vakaların %4’ünde hipotiroidizm ve sadece bir hastada polikistik over hastalığı tespit edildi. 4 hastada belirgin bir neden saptanamadı. Sonuç: Çalışmamızda, ilaca bağlı hiperprolaktinemi en sık saptanabilir etiyolojiydi ve prokinetikler en sık nedendi. Daha önceki çalışmalarda ise hipofiz adenomu ve onun ardından nöroleptik ilaçlar en yaygın nedenler olarak bulunmuştu. Sorumlu olan ilacın kesilmesiyle tüm hastalarda hiperprolaktinemi ortadan kalktı.
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