Diagnosis and management of hyperprolactinemia: results of a Brazilian multicenter study with 1234 patients.
OBJECTIVE
The aim of the study was to evaluate clinical and laboratorial features of 1234 patients with different etiologies of hyperprolactinemia, as well as the response of 388 patients with prolactinomas to dopamine agonists.


METHODS
A total of 1234 hyperprolactinemic patients from 10 Brazilian endocrine centers were enrolled in this retrospective study.


METHODS
PRL measurement, thyroid function tests, and screening for macroprolactin were conducted.


RESULTS
Patients were subdivided as follows: 56.2% had prolactinomas, 14.5% drug-induced hyperprolactinemia, 9.3% macroprolactinemia, 6.6% non-functioning pituitary adenomas, 6.3% primary hypothyroidism, 3.6% idiopathic hyperprolactinemia, and 3.2% acromegaly. Clinical manifestations were similar irrespective of the etiology of the hyperprolactinemia. The highest PRL levels were observed in patients with prolactinomas but there was a great overlap in PRL values between all groups. However, PRL>500 ng/ml allowed a clear distinction between prolactinomas and the other etiologies. Cabergoline (CAB) was more effective than bromocriptine (BCR) in normalizing PRL levels (81.9% vs 67.1%, p<0.0001) and in inducing significant tumor shrinkage and complete disappearance of tumor mass. Drug resistance was observed in 10% of patients treated with CAB and in 18.4% of those that used BCR (p=0.0006). Side-effects and intolerance were also more common in BCR treated patients.


CONCLUSIONS
Prolactinomas, drug induced hyperprolactinemia, and macroprolactinemia were the 3 most common causes of hyperprolactinemia. Although PRL levels could not reliably define the etiology of hyperprolactinemia, PRL values >500 ng/ml were exclusively seen in patients with prolactinomas. CAB was significantly more effective than BCR in terms of prolactin normalization, tumor shrinkage, and tolerability.
Division of Endocrinology, Hospital das Clínicas, Federal University of Pernambuco, Recife, Pernambuco, Brazil. lvilar@gmail.com
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Vilar
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Freitas
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Naves
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Casulari
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Azevedo
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Montenegro
A I
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Barros
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Faria
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Nascimento
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Lima
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Nóbrega
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Cruz
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Mota
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Ramos
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Violante
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Lamounier Filho
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Gadelha
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Czepielewski
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Glezer
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Bronstein
D000293:Adolescent; D000328:Adult; D000368:Aged; D001938:Brazil; D001971:Bromocriptine / Q000627:therapeutic use; D018491:Dopamine Agonists / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006966:Hyperprolactinemia / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011388:Prolactin / Q000097:blood; D012189:Retrospective Studies; D016896:Treatment Outcome
D018491:Dopamine Agonists; D001971:Bromocriptine; D011388:Prolactin