Hyperprolactinemia
SAQ.
A 20 year old female presented with bilateral nipple discharge and amenorrhea for 3 months.
- Mention 3 important history for this condition.
- Drug history
- Recent pregnancy
- Menstrual history
- What are the investigations would you suggest?
- S. Prolactin
- Upper normal limit 500 mIU/L (24 ng/ml)
- Non pregnant and lactating mother 500-1000 mIU/L (24-47 ng/ml) due to stress or drugs.
- Microprolactinoma and disconnection hyperprolactinemia 1000-5000 mIU/L
- Macroprolactinoma > 5000 mIU/L
- LH, FSH, S. Testosterone, Estradiol
- TSH, FT4
- Creatinine
- USG of Abdomen
- Pregnancy test
- CT/MRI of brain/Pituitary gland
- What is the hook effect and how to overcome this problem?
- Hook effect: Extremely high prolactin level may be falsely reported as normal or modestly elevated due to saturation of assay antibodies, known as hook effect.
- Advice: Repeat S. Prolactin 1:100 times dilution