Macroprolactinemia and empty sella syndrome

Oumayma Zarrouk; Taieb Ach; Rihab Kochtali; Ghada Saad; Abdelkrim Asma Ben; Chaieb Molka Chadli; Koussay Ach

doi:10.1530/endoabs.99.EP893

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Endocrine Abstracts (2024) 99 EP893 | DOI: 10.1530/endoabs.99.EP893

ECE2024 Eposter Presentations Pituitary and Neuroendocrinology (214 abstracts)

Macroprolactinemia and empty sella syndrome

Oumayma Zarrouk ¹ , Taieb Ach ¹ , Rihab Kochtali ¹ , Ghada Saad ¹ , Asma Ben Abdelkrim ¹ , Molka Chadli Chaieb ¹ & Koussay Ach ¹

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¹University Hospital of Farhat Hached, Endocrinology Departement, Sousse

Introduction: Macroprolactinemia is a polymeric form of prolactin release that leads to clinically paucisymptomatic presentations. It can be isolated or associated with other causes of hyperprolactinemia. We report the case of macroprolactinemia discovered in a patient being treated for an empty sella turcica.

Case report: This concerns a 47-year-old patient, monitored since the age of 31 for moderate idiopathic hyperprolactinemia discovered following bilateral galactorrhea and amenorrhea. There was no associated medication use. Her exploration revealed a prolactin level of 635 mIU/l. Thyroid function tests were normal (T4=10.2 ng/l, TSH=1.76 mIU/l). A brain CT scan showed an empty sella turcica. The patient’s evolution under 5 mg/day of dopamine agonists was marked by the occurrence of pregnancy with persistent moderate hyperprolactinemia in the postpartum period. The patient reached menopause at the age of 47, with elevated gonadotropins (FSH=78 mIU/ml, LH=33 mIU/ml, and estradiol: 35 pg/ml). Consequently, the treatment was discontinued, and regular clinical monitoring was initiated. Chromatography revealed a predominance of the macroprolactin form with 4.8% monomeric prolactin, 5% big prolactin, and 83% big big prolactin.

Conclusion: Our observation suggests that macroprolactinemia can be associated with classical etiologies of moderate hyperprolactinemia, such as an empty sella turcica. Detecting it could potentially avoid the need for dopamine agonist treatment.