Background: Raised prolactin is a frequent reason for referral to endocrine clinics. Prolactinomas are the most common functioning pituitary tumours. Medical management with dopamine agonists remains the treatment of choice. MHRA advises baseline echocardiograms within 36 months and then 612 monthly in patients taking dopamine agonists due to a potential risk of cardiac valvular fibrosis though the evidence for fibrosis at endocrine doses remains limited. Aim: The aim of this study was to audit whether we are adhering to the MHRA recommendations. We also identified the aetiology of hyperprolactinemia, the dopamine agonist used and radiological findings where applicable. Methods: Patients who had prolactin levels checked in the last four months were identified from a biochemistry data base and case notes reviewed retrospectively. Results: 84 patients had prolactin levels checked in this time, 45 were seen in endocrine clinic. 32/45 were female. Apart from two patients who had drug induced hyperprolactinemia with moderately elevated prolactins, all had an MRI of the pituitary. 16 had microadenomas, 15 had macroadenomas (45%) and 2 had non-functioning pituitary tumour. The aetiology of hyperprolactinemia was drug induced in 20%, prolactinomas in 69%, stalk compression in 4% and idiopathic in 7%. All patients with macroadenoma had dynamic pituitary function tests done. 3 patients with macroadenomas had trans sphenoidal surgery. All the other patients were managed medically. Six received quinagolide. 26 patients had cabergoline and 4 bromcriptine. Of these, 26/30 had baseline and yearly echocardiograms. Trivial tricuspid regurgitation was the most common finding in echocardiogram. None of the patients had clinically significant valvulopathy. 24/30 patients had pulmonary function tests to look for pulmonary fibrosis. Conclusions- A surprisingly high number had a macroprolactinoma. 72% patients had echos as per MHRA guidance.
Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.
Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.