Patients with idiopathic hyperprolactinemia have a higher risk for anterior pituitary hormone deficiency that may require hormone therapy compared with patients with microprolactinoma, study data show.
“Dynamic assessment of anterior pituitary function is not standard practice in the investigation of patients with microprolactinoma or idiopathic hyperprolactinemia,” the researchers wrote in the study background. “Although hyperprolactinemia causes suppression of gonadotropin secretion, with hypogonadotropic hypogonadism, hyposecretion of the other anterior pituitary hormones is not considered to occur with sufficient frequency to justify routine testing.”
Christopher J. Thompson, MD, professor in the department of endocrinology at Beaumont Hospital in Dublin, and colleagues evaluated 56 patients with hyperprolactinemia to determine the frequency and clinical significance of anterior pituitary hormone deficiencies. Thirty-five participants were MRI-positive for prolactinoma, and 21 had idiopathic hyperprolactinemia.
Abnormal pituitary function was identified in 8.57% of participants with MRI-positive microprolactinemia; all three were female, two had adrenocorticotropic hormone (ACTH) deficiency alone and one had ACTH and GH deficiency combined.
Anterior pituitary hormone deficiencies were identified in 42% of participants with idiopathic hyperprolactinemia; two had ACTH deficiency alone, two had GH deficiency alone and five had combined ACTH and GH deficiency. Hormone replacement was required in one participant with MRI-positive prolactinoma compared with six in the idiopathic hyperprolactinemia group.
The incidence of hypopituitarism was higher in the idiopathic hyperprolactinemia group compared with the MRI-positive macroprolactinoma group (P = .0053).
“Following our documentation of the significantly greater incidence of anterior pituitary hormone deficits in patients with presumed idiopathic hyperprolactinemia, we feel that dynamic pituitary testing should be a routine part of patient assessment for this patient group,” the researchers wrote. “Identification of pituitary hormone deficiencies allows appropriate treatment, to prevent the significant morbidity and mortality associated with hypopituitarism. In addition, in those patients with definite abnormalities, investigations to diagnose the underlying disease process causing hyperprolactinemia and hypopituitarism should be undertaken.” – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.