HYPERPROLACTINAEMIA IN NONLACTATING WOMEN

Abstract

A prospective study was conducted from July 1995 to February 2002 in gynaecology clinics of various teaching hospitals in Islamabad and Lahore. Patients presenting with symptoms suggestive of hyperprolactinaemia such as oligomenorrhea, amenorrhea, galactorrhea and infertility were screened for their prolactin levels, after recording their histories and relevant examinations. Those with prolactin levels more than 25 ng/ml were included in the study, and an informed consent was taken. Their blood samples were taken for a hormone profile including FSH, progesterone, estradiol, as well as prolactin, and were subsequently repeated. Radiography for the pituitary fossa and perimetry for the field of vision (hemianopsia) were done in all the patients. Patients with prolactin levels more than 200ng/ml had high resolution MR imaging of their pituitary fossa. It was done selectively in the patients with mild and moderately elevated prolactin levels. Statistical analysis of the data was done. Results of the study demonstrate that 19,266 gynaecological patients were examined and n=830; 4.31 % subjects were diagnosed with hyperprolactinaemia. All of the patients were of reproductive age ranging from 16 to 49 years. Hyperprolactinaemia is significantly more prevalent among unmarried patients than in married patients (P<O.OOl) when compared at age class 21 years to 35 years. The positive history of spontaneous abortion was present in n=296; 35.66% subjects. There is a highly significant negative correlation (P<0.02) between prolactin levels and incidence of abOliion. The predominant symptoms were oligomenorrhea / amenorrhea, (n=748; 90.12%), infertility (n=266; 32.05%) and galactorrhea (n=248; 29.88%). Number of hyperprolactinemic patients with primary infertility is significantly (P=0.0354) higher than those with secondary infertility of up to 2 years duration. Married hyperprolactinemic patients with livebirths have the highest incidence of galactorrhea. The number of galactorrhea patients is significantly high in married patients with livebirths when compared to unmarried patients (P<O.OOl). Among married patients galactorrhea is significantly associated with those who had livebirths compared to patients with no livebirths (P=O.0143). Married hyperprolactinemic patients with galactorrhea are significantly higher in number compared to unmarried patients when distributed in relation to unilateral and bilateral involvement of the breast (P=0.0020). The symptoms manifesting due to hypoestrogenaemia among hyperprolactinemic patients were vulvovaginal atrophy symptoms in n=392; 47.23% and decreased libido in n=202; 24.34% subj ects. Prolactin levels were (25-100ng/ml) mildly elevated in n=576; 69.40%, moderately elevated (l01-200ng/ml) in n=185; 22.29% and high (>201ng/ml) in n=69; 8.31% patients. Causes ofhyperprolactinaemia were idiopathic, (n=398; 47.95%) secondary (n=254; 30.60%) and prolactinomas (n=l78; 21.45%). Of these prolactinoma patients, n=l lO; 13.25% had microadenomas and n=68; 8.19% were macroadenomas. A strong association of micro adenoma with mild and moderately elevated prolactin and that of macro adenoma with higher levels of prolactin were observed (P<O.OOl ). Among macroadenoma patients (n=5; 0.60%) had supra seller expansion causing partial or complete hemianopsia. Serum progesterone was decreased in n=782; 94 .20% patients, estradiol in n=7 16; 86.27% patients and FSH was low in n=726; 87.47% patients. However none of the patients had raised concentration of any of these hOlIDones. In conclusion incidence of hyperprolactinaemia is 4311 000 in the studied population and it causes significant morbidity among gynaecological patients. Though this incidence is higher, symptoms are similar to the studies done in other populations in other parts of the world. A highly significant negative correlation between prolactin levels and number of abortions is observed. Serum prolactin levels >200ng/ml are strongly associated with macro adenoma and <200ng/ml with microadenoma. If MRI could be employed more frequently in patients with moderately elevated prolactin concenh·ation some more microadenomas are likely to be diagnosed among idiopathic hyperprolactinaemia patients.