Hyperprolactinemia

Domperidone minimally crosses the BBB it acts in the CTZ which lies outside of the BBB. As such, domperidone is less likely to cause the centrally-mediated adverse effects seen with metoclopramide and has an estimated overall incidence of 5% to 10%.1,30 However, domperidone has been associated with prolonged QT intervals, cardiac arrhythmias, and sudden death.31 It should not be used for patients with underlying long QT interval or for those on other medications that prolong the QT interval. Both metoclopramide and domperidone can cause hyperprolactinemia, galactorrhea, and gynecomastia. 

Identify the clinical features of patients with hyperprolactinemia. 

Select appropriate pharmacologic and nonpharmacologic treatments for patients with hyperprolactinemia based on patient-specific factors. 

Dopamine agonists are the first-line treatment of choice for all patients with hyperprolactinemia transsphenoidal surgery and radiation therapy are reserved for patients who are resistant to or severely intolerant of pharmacologic therapy. 

Hyperprolactinemia commonly affects women of reproductive age more than men. Although this disorder occurs in less than 1% of the general population, the estimated prevalence in women with reproductive disorders (e.g., amenorrhea) is as high as 9% to 17%.43 Numerous etiologies of hyperprolactinemia are presented in Table 43-5.43,44 Any medications that block... 

Hyperprolactinemia most commonly affects women of reproductive age and is very rare in men. 

The prolonged suppression of estrogen in pre-menopausal women with hyperprolactinemia leads to decreases in bone mineral density and significant risk for the development of osteoporosis. 

Risk for ischemic heart disease may be increased with untreated hyperprolactinemia. 

Because hyperprolactinemia is often associated with hypogonadism, the goals for management of hyperprolactinemia are to restore the clinical consequences of hypogonadism and reduce its associated risk for osteoporosis44 (Table 43-7). 

Given this information, what signs and symptoms does WB have for hyperprolactinemia ... 

FIGURE 43-4. Approach to management of hyperprolactinemia.44 MRI = magnetic resonance imaging. (Reprinted, with permission, from Serri O, Chik CL, Ezzat S. Diagnosis and management of hyperprolactinemia. Can Med Assoc J 2003 169(9) 575-581. 2003 by CMA Media, Inc.)... 

Most women with hyperprolactinemia require dopamine agonist therapy to achieve regular ovulatory cycles and pregnancy. Since restoration of the ovulatory cycle may occur within 1 week of initiating therapy, caution patients regarding their potential to become pregnant.51... 

Monitor clinical symptoms associated with hyperprolactinemia every month for the first 3 months to assess therapeutic efficacy and assist with dose titration. 

Once the prolactin level is normalized and clinical symptoms of hyperprolactinemia have resolved, monitor prolactin level every 6 to 12 months.43,44,46... 

Discontinuation of therapy in patients with macroprolactinomas usually leads to tumor regrowth and recurrence of hyperprolactinemia. This decision warrants careful consideration. 

Assess patient s clinical signs and symptoms of hyperprolactinemia. 

Review the available diagnostic data to determine severity and exclude other common causes of hyperprolactinemia. 

Obtain a thorough medication history to exclude medication-induced hyperprolactinemia. 

If the prolactin level remains normal for 2 years, reassess the need to continue treatment. Make sure that the patient is taking the lowest effective dose for management of hyperprolactinemia. 

Verhelst J, Abs R. Hyperprolactinemia pathophysiology and management. Treat Endocrinol 2003 2(l) 23-32. 

If hyperprolactinemia is identified as the cause of amenorrhea, the use of bromocriptine, a dopamine agonist, results in a reduction in prolactin concentrations and the resumption of menses. 

Hyperprolactinemia Elevated serum prolactin characterized by prolactin serum concentrations greater than 20 ng/mL (20 mcg/L) in men or 25 ng/mL (25 mcg/L) in women. 

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