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Diagnosis and management of hyperprolactinemia: Results of a Brazilian multicenter study with 1234 patients

Authors
  • VILAR, L.
  • FREITAS, M. C.
  • NAVES, L. A.
  • CASULARI, L. A.
  • AZEVEDO, M.
  • MONTENEGRO JR., R.
  • BARROS, A. I.
  • FARIA, M.
  • NASCIMENTO, G. C.
  • LIRNA, J. G.
  • NOBREGA, L. H.
  • CRUZ, T. P.
  • MOTA, A.
  • RAMOS, A.
  • VIOLANTE, A.
  • LAMOUNIER FILHO, A.
  • GADELHA, M. R.
  • CZEPIELEWSKI, M. A.
  • GLEZER, A.
  • BRONSTEIN, M. D.
Publication Date
Jan 01, 2008
Source
Biblioteca Digital da Produção Intelectual da Universidade de São Paulo (BDPI USP)
Keywords
Language
English
License
Unknown
External links

Abstract

Objective: The aim of the study was to evaluate clinical and laboratorial features of 1234 patients with different etiologies of hyper-prolactinemia, as well as the response of 388 patients with prolactinomas to dopamine agonists. Design, setting, and patients: A total of 1234 hyperprolactinemic patients from 10 Brazilian endocrine centers were enrolled in this retrospective study. Main outcome measure: PRL measurement, thyroid function tests, and screening for macroprolactin were conducted. Results: Patients were subdivided as follows: 56.2% had prolactinomas, 14.5% drug-induced hyperprolactinemia, 9.3% macroprolactinemia, 6.6% non-functioning pituitary adenomas, 6.3% primary hypothyroidism, 3.6% idiopathic hyperprolactinemia, and 3.2% acromegaly. Clinical manifestations were similar irrespective of the etiology of the hyperprolactinemia. The highest PRL levels were observed in patients with prolactinomas but there was a great overlap in PRL values between all groups. However, PRL>500 ng/ml allowed a clear distinction between prolactinomas and the other etiologies. Cabergoline (CAB) was more effective than bromocriptine (BCR) in normalizing PRL levels (81.9% vs 67.1%, p<0.0001) and in inducing significant tumor shrinkage and complete disappearance of tumor mass. Drug resistance was observed in 10% of patients treated with CAB and in 18.4% of those that used BCR (p=0.0006). Side-effects and intolerance were also more common in BCR-treated patients. Conclusion: Prolactinomas, drug-induced hyperprolactinemia, and macroprolactinemia were the 3 most common causes of hyperprolactinemia. Although PRL levels could not reliably define the etiology of hyperprolactinemia, PRL values >500 ng/ml were exclusively seen in patients with prolactinomas. CAB was significantly more effective than BCR in terms of prolactin normalization, tumor shrinkage, and tolerability.

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