Hyperprolactinemia: a rare association between primary hypothyroidism and macroprolactinoma

Eya Sassi; Sondes Chermiti; Bochra Zitoun; Hajer Marzouk; Issam Kharrat; Yosra Hasni; Wided Debbabi

doi:10.1530/endoabs.99.EP1156

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Endocrine Abstracts (2024) 99 EP1156 | DOI: 10.1530/endoabs.99.EP1156

ECE2024 Eposter Presentations Pituitary and Neuroendocrinology (214 abstracts)

Hyperprolactinemia: a rare association between primary hypothyroidism and macroprolactinoma

Eya Sassi ¹ , Sondes Chermiti ² , Bochra Zitoun ² , Hajer Marzouk ² , Issam Kharrat ² , Yosra Hasni ³ & Wided Debbabi ^2,2

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¹Ibn Aljazzar Hospital, Endocrinology, Kairouan, Tunisia; ²Ibn Aljazzar Hospital, Endocrinology, Kairouan, Tunisia; ³Farhat Hached Hospital, Sousse, Tunisia

Introduction: Primary hypothyroidism is a common cause of hyperprolactinemia. TSH measurement is part of the first-line investigation of hyperprolactinemia wich usually disappear after L-thyroxine therapy. the presence of pituitary hyperplasia mimicking a pituitary macroadenoma has been reported by several authors, but coexistence oh primary hypothyroidism and prolactinoma is rarely reported.

Case: We report a rare case of hyperprolactinemia revealing the association of primary hypothyroidism with a pituitary microprolactinoma. was 29 years old referred to endocrinology consultation for hyperprolactinemia (Prolactin level: 120 ng/ml) discovered in the context of infertility and secondary amenorrhea. Hyperprolactinemia was confirmed, and the first-line investigation concluded to peripheral hypothyroidism (TSH>60 mUI/l) secondary to autoimmune thyroiditis (antiTPO antibodies: 453 mUI/l). Management consisted in hormone replacement therapy with thyroxine. Clinical evolution was marked with hormonal normalization 3 months later but persisting amenorrhea and hyperprolactinemia justifying pituitary MRI leading to the diagnosis of macroprolactinoma. Anti-dopaminergic treatment was prescribed with prolactin levels normalization, pituitary microadenoma size reduction and recovery of menstrual cycles.

Conclusion: Hyperprolactinemia is common in primary hypothyroidism, due to compensatory increase in the discharge of central hypothalamic TRH as a result of low thyroxine. Association of primary hypothyroidism and prolactinoma as cause of hyperprolactinemia is a rare condition which requires long-term follow-up to avoid missing the diagnosis and preserve the gonadal function and fertility.