Hyperprolactinaemia in 271 women: up to three decades of clinical follow‐up

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Abstract
Summary: Objective  To characterize women with hyperprolactinaemia at diagnosis and to assess the effect of treatment after long duration of the disease.Design  Retrospective chart review.Patients and measurements  Two hundred and seventy‐one women with hyperprolactinaemia at the Karolinska University Hospital, Stockholm, Sweden between 1974 and 2002 were evaluated retrospectively. Criterion for inclusion was elevated S‐PRL (≥ 20 µg/l) found on at least two occasions. Secondary hyperprolactinaemia was excluded. The patients were followed for a median time period of 111 (6–348) months. Two hundred and forty patients were treated with dopamine agonists, 17 underwent surgery, seven received radiotherapy and seven were followed without treatment.Results  Mean age at diagnosis was 31 (± 9·5) years and median PRL level was 72 (25–3500) µg/l. Menstrual disturbances were present in 87% of the women of reproductive age and 47% had galactorrhoea. Microadenomas were found in 63%, macroadenomas in 8% and idiopathic hyperprolactinaemia in 29%. Patients with menstrual disturbances had higher PRL levels than women with normal menstrual function (P < 0·001). We found no differences in PRL levels between patients with or without galactorrhoea (P = 0·578). At the end of clinical follow‐up, menstrual cycle was normalized in 94% and galactorrhoea disappeared in 94%. In the medically treated patients, median PRL levels decreased from 70 (25–3100) to 13 (0–89) µg/l, (P < 0·0001). Normalization of PRL level was achieved in 71% of the patients and 80% showed a total or partial degree of tumour shrinkage. In the surgically treated patients, 53% had normal PRL levels without medication at follow‐up.Conclusion  Medical treatment was effective in correcting hypogonadism, normalizing PRL levels and reducing tumour size in the majority of the patients after short‐term treatment and also in the long run. However, the possibility of transsphenoidal surgery in specific cases must be considered.

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