Clinical Profile and Changing Etiological Spectrum of Hyperprolactinemia at a Tertiary Care Endocrine Facility

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.