Endocrine Abstracts

Background: Hyperprolactinemia is often seen in women of reproductive age (20–35 years), most often due to microprolactinoma. However, prolactinomas do occur in older women.

Objective: To analyze clinical features of hyperprolactinemia in women >40 years

Material and methods: Clinical and biochemical data of 185 women with pathological hyperprolactinemia were analyzed.

Results: Seventy (37.8%) patients had microprolactinomas (MI), 57 (30.8%) – macroprolactinomas (MA), and 58 (31.4%) – non-tumoral hyperprolactinemia (NT). Among them, 26(36.1% of corresponding subgroup) with MI, 27(46.6%) with NT and 37(64.9%) with MA were >40 years of age. Menstrual disturbances and infertility issues are key factors for prolactin measurement but among these women, it was a reason to visit doctor only in few cases. In most cases with onset of hyperprolactinemia within 40–50 years of age, women themselves or their gynecologists considered amenorrhea as a natural postmenopause, missing the correct diagnosis. It was characteristic for hyperprolactinemic women that they did not experience vasomotor climacteric symptoms. Weight gain was common (68% women) but was also considered as climacteric and result of ageing. Headache and visual impairment were common causes for referral later on, and hyperprolactinemia was found due to hormonal investigation after MR-visualization of pituitary tumor. In some cases with prolactin levels 1300–1900 mMU/l, differential diagnosis was required between hyperprolactinemia due to pituitary stalk compression and prolactinomas with moderate secreting activity (“hook” phenomena was excluded). However, significant tumor shrinkage and (in some cases) restoration of regular menstrual cycle after 3–6 months of cabergoline treatment confirmed prolactinoma.

Conclusion: If a woman over 40 has menstrual irregularity or amenorrhea and does not experience any vasomotor symptom, it is a reason to prove a natural menopause by measuring high FSH levels (>25 MU/l). In cases of lower FSH levels it is reasonable to consider pathological hyperprolactinemia.