Hyperprolactinaemia in 271 women: up to three decades of clinical follow-up.
OBJECTIVE
To characterize women with hyperprolactinaemia at diagnosis and to assess the effect of treatment after long duration of the disease.


METHODS
Retrospective chart review.


METHODS
Two hundred and seventy-one women with hyperprolactinaemia at the Karolinska University Hospital, Stockholm, Sweden between 1974 and 2002 were evaluated retrospectively. Criterion for inclusion was elevated S-PRL (> or = 20 microg/l) found on at least two occasions. Secondary hyperprolactinaemia was excluded. The patients were followed for a median time period of 111 (6-348) months. Two hundred and forty patients were treated with dopamine agonists, 17 underwent surgery, seven received radiotherapy and seven were followed without treatment.


RESULTS
Mean age at diagnosis was 31 (+/- 9.5) years and median PRL level was 72 (25-3500) microg/l. Menstrual disturbances were present in 87% of the women of reproductive age and 47% had galactorrhoea. Microadenomas were found in 63%, macroadenomas in 8% and idiopathic hyperprolactinaemia in 29%. Patients with menstrual disturbances had higher PRL levels than women with normal menstrual function (P < 0.001). We found no differences in PRL levels between patients with or without galactorrhoea (P = 0.578). At the end of clinical follow-up, menstrual cycle was normalized in 94% and galactorrhoea disappeared in 94%. In the medically treated patients, median PRL levels decreased from 70 (25-3100) to 13 (0-89) microg/l, (P < 0.0001). Normalization of PRL level was achieved in 71% of the patients and 80% showed a total or partial degree of tumour shrinkage. In the surgically treated patients, 53% had normal PRL levels without medication at follow-up.


CONCLUSIONS
Medical treatment was effective in correcting hypogonadism, normalizing PRL levels and reducing tumour size in the majority of the patients after short-term treatment and also in the long run. However, the possibility of transsphenoidal surgery in specific cases must be considered.
Berinder
Katarina
K
Department of Endocrinology, Metabolism and Diabetology, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden. katarina.berinder@karolinska.se
Stackenäs
Ingela
I
Akre
Olof
O
Hirschberg
Angelica Lindén
AL
Hulting
Anna-Lena
AL
D000236:Adenoma / Q000150:complications / Q000188:drug therapy* / Q000601:surgery; D000328:Adult; D000568:Amenorrhea / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D018491:Dopamine Agonists / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D005687:Galactorrhea / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D006801:Humans; D006966:Hyperprolactinemia / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery; D010911:Pituitary Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000601:surgery; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D018491:Dopamine Agonists