Tumoral versus non-tumoral hyperprolactinemia in children and adolescents: possible usefulness of the domperidone test.
The aim of this study was to evaluate the usefulness of the domperidone test for the difficult diagnosis between functional and tumoral hyperprolactinemia. We evaluated 36 patients, aged 5-18 years, 14 (12 F, 2 M) with hyperprolactinemia (non-tumoral: 10; pituitary adenoma: 4) and 22 individuals as a control group (prepubertal: 5 F, 8 M; pubertal: 4 F, 5 M). Basal prolactin (PRL) (IRMA-DPC), T4 and TSH and PRL 30 min post-domperidone (0.2 mg/kg b. wt i.v.) were measured. Non-tumoral hyperprolactinemic females showed basal PRL: 45 (29-80) (median and range) ng/ml; post-domperidone: 208 (116-290) ng/ml; delta PRL (PRL 30' - PRL 0'): 167 (77-252) ng/ml; and PRL ratio (PRL 30'/PRL 0'): 3.9 (2.3-7.6). Females with pituitary adenoma showed basal PRL: 129 (125-660) ng/ml; post-domperidone: 202 (150-535) ng/ml; delta PRL: 73 (25-135) ng/ml; and ratio: 1.2 (0.8-1.6). Two males, one with a non-tumoral hyperprolactinemia and the other one with a pituitary adenoma, presented, respectively, PRL 0':45, 160; PRL 30':130, 173; delta: 85, 13; ratio: 2.9, 1.1. All non-tumoral patients showed a PRL ratio (30'/0') > 2.3, while no patient with pituitary adenoma had a ratio > 1.6.


CONCLUSIONS
PRL response to domperidone allowed us to characterize hyperprolactinemias, although the presence of a blunted response should be confirmed in a larger number of patients with tumors with 'low' PRL levels (dependence on etiology or basal PRL level?).
Fideleff
Hugo L
HL
Endocrinology Unit, Medicine Department, Hospital T. Alvarez, Buenos Aires, Argentina. hugofideleff@arnet.com.ar
Azaretzky
Miriam
M
Boquete
Hugo R
HR
Pujol
Andrea B
AB
Honfi
Margarita
M
Suárez
Martha G
MG
Fideleff
Gabriel
G
Giaccio
Ana V
AV
D000236:Adenoma / Q000150:complications* / Q000000981:diagnostic imaging; D000293:Adolescent; D002648:Child; D004294:Domperidone; D018492:Dopamine Antagonists; D005260:Female; D006801:Humans; D006966:Hyperprolactinemia / Q000175:diagnosis* / Q000209:etiology*; D008279:Magnetic Resonance Imaging; D008297:Male; D010911:Pituitary Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging; D011388:Prolactin / Q000097:blood; D011859:Radiography; D011863:Radioimmunoassay; D012727:Sex Characteristics
D018492:Dopamine Antagonists; D004294:Domperidone; D011388:Prolactin