Hyperprolactinemia
Big picture
Hyperprolactinemia means excess serum prolactin, most importantly causing hypogonadotropic hypogonadism: high prolactin suppresses hypothalamic gonadotropin-releasing hormone (GnRH) → ↓ luteinizing hormone (LH) and ↓ follicle-stimulating hormone (FSH) → ↓ estrogen/testosterone → infertility, menstrual disturbance, sexual dysfunction, and osteoporosis risk.
The exam pattern is very classic:
Woman with amenorrhea + galactorrhea ± infertility = measure prolactin and exclude pregnancy + hypothyroidism + drugs. Man with low libido/erectile dysfunction + headache/visual defect = think macroprolactinoma.
The first-line treatment of a symptomatic prolactinoma is dopamine agonist therapy, preferably cabergoline in most current guidelines; the older exam question file emphasizes dopamine agonist therapy and mentions bromocriptine as a traditional first choice in Hungary. Dopamine agonists lower prolactin, restore gonadal function, and shrink the tumor. ([OUP Academic][1])
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