Pituitary imaging is indicated for the evaluation of hyperprolactinemia

Bayrak, Aykut; Saadat, Peyman; Mor, Eliran; Chong, Lisa; Paulson, Richard J.; Sokol, Rebecca Z.

doi:10.1016/j.fertnstert.2005.01.102

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Volume 84, Issue 1 , Pages 181-185, July 2005

Pituitary imaging is indicated for the evaluation of hyperprolactinemia

Presented at the 51st Annual Meeting of the Pacific Coast Reproductive Society, April 23–27, 2003, Rancho Mirage, California.

Aykut Bayrak, M.D.
- Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California
- Reprint requests: Aykut Bayrak, M.D., Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, 1240 N Mission Road, Room 8K9, Los Angeles, California 90033 (FAX: 323-226-2850
Peyman Saadat, M.D.
- Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California
Eliran Mor, M.D.
- Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California
Lisa Chong, M.D.
- Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California
Richard J. Paulson, M.D.
- Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California
Rebecca Z. Sokol, M.D., M.P.H.
- Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California

Received 1 June 2004; accepted 4 January 2005.

Objective

To evaluate the signs and symptoms associated with hyperprolactinemia and establish guidelines for a minimal serum PRL level for which pituitary imaging is indicated.

Design

Retrospective study.

Setting

Reproductive endocrinology clinic in a university hospital.

Patient(s)

One hundred four consecutive patients with hyperprolactinemia, mean age 30 ± 6.5 (range 19–44) years.

Intervention(s)

Classification of clinical symptoms, serum hormone measurements, and pituitary magnetic resonance imaging (MRI).

Main Outcome Measure(s)

Incidence of presenting symptoms, serum PRL levels, and pituitary tumor size.

Result(s)

Median (range) PRL value was 82.6 ng/mL (25–1,342). Reported symptoms from most to least common were infertility (48%), headaches (39%), oligoamenorrhea (29%), galactorrhea (24%), and visual changes (13%). Hypothyroidism was diagnosed in 2 of 104 (1.9%) patients. Of 86 patients who had pituitary imaging, 23 (26%) had normal findings and 63 (74%) had pituitary tumor; of these, 47 (55% of total imaged) had microadenomas and 16 (19% of total imaged) had macroadenomas. There was a statistically significant association between the tumor size and the PRL level. However, 11% of the patients with microadenomas had PRL levels >200 ng/mL, and 44% of the patients with macroadenomas had PRL levels between 25 and 200 ng/mL.

Conclusion(s)

The most common symptoms in the population studied were infertility and headaches. Coexisting thyroid disease was an uncommon finding. Most patients had a pituitary tumor on MRI. Although tumor size correlated with the serum PRL level, some macroadenomas were detected in women with only moderately elevated PRL values. On the basis of these findings, pituitary imaging should be obtained to identify pituitary tumors in all patients with persistently elevated PRL levels.

Key Words: Hyperprolactinemia , prolactin , MRI , hypothyroidism , pituitary tumor , infertility