hyperprolactinemia
HYPERPROLACTINEMIA
Treatment Guideline Chart
Hyperprolactinemia is the presence of elevated prolactin levels that occurs in about one-thirds of patients w/ chronic kidney disease & resolves after successful transplantation.
It may cause visual field defects or headache in both men and women.
In women, signs and symptoms include menstrual irregularity, galactorrhea, infertility, vaginal dryness, dyspareunia, loss of libido and reduction in vertebral bone density (in sustained, pronounced hyperprolactinemia).
While in men, signs and symptoms include diminished libido, hypogonadism, gonadotrophin suppression, osteopenia, decreased muscle mass, and decreased facial hair that may occur in prolonged hyperprolactinemia.

Surgical Intervention

Transsphenoidal Surgery

  • Preferred method
    • Craniotomy is rarely performed

Indications:

  • Patients who are resistant to or exhibit non-tolerance to optimal medical therapy
  • Patients with intrasellar tumor and long-term medical treatment is not acceptable
  • Patients with tumors pressing on the optic chiasm
  • Effects:
    • Microprolactinomas: Initially 70% achieve prolactin (PRL) normalization
    • Macroprolactinomas: Only 30% are successfully resected
    • Recurrence of microprolactinomas and macroprolactinomas occurs in 20% of patients within 1 year of surgery
    • Recurrence rates reach 50% in long-term follow-up of macroprolactinomas
  • Potential complications: Usually infrequent when performed by experienced surgeons
    • Mortality rate: 0.3%
    • Morbidity rate: 0.4%
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