Endocrine Abstracts

Aim: Role of Endocrine Specialist Nurse (ESN) in performing cannulated prolactin and subsequent impact on outpatient clinic activities.

Introduction: Hyperprolactinemia is a common condition in endocrine clinical practice. It may occur in any sex, at any age and its prevalence and incidence depend on study population. The most common physiological causes of elevated prolactin are stress, lactation, pregnancy and exercise. Non-physiological causes include medications, pituitary and systemic disorders and medications¹. Regardless of underlying aetiology hyperprolactinemia may cause galactorrhoea, amenorrhoea, infertility and erectile dysfunction in addition to several adverse health outcomes such as cardiac disease, cancer, osteoporosis, autoimmune conditions. 40 patients (11 men and 29 women) with a mean age of 32 yrs were referred by the consultant endocrinologists for cannulated prolactin over a 12-month period in 2023. All patients were originally referred by their GP with elevated prolactin following various presentations, pituitary adenomas (4), erectile dysfunction (3), irregular periods (3), fatigue (3), short stature (2), infertility (1), galactorrhoea (1), sweating (1), asymptomatic (22). Their elevated prolactin levels ranged 355 to 1281 miu/l in men and 499 to 2149 miu/l in women, with a mean prolactin of 891 miu/l in both sexes.

Method: All patients underwent a cannulated prolactin following our joint Endocrine guidelines. This involved placing a cannula in the arm and taking a sample of blood at insertion for prolactin. The patient was then left to sit and relax for 60 mins before a second sample of blood was withdrawn from the cannula for prolactin.

Results: 21 patients (10 men and 11 women) had a normal cannulated prolactin at 60 mins with a range of 323 to 131 miu/l, mean=244 miu/l in men and 435 to 260 miu/l, mean 360 miu/l in women. 21 (52%) of patient with normal cannulated prolactin were reassured and discharged back to their general practitioner (GP). 19 patients with non-suppressed prolactin (range of 409 to 1608 miu/l) were subsequently seen in consultant endocrine clinic for further investigation and treatment including two patients who were on Duloxetine and Olanzapine.

Conclusion: The above highlights the importance of a dedicated endocrine team with the role of the ESN being paramount to:

1) facilitate and ensure timely and accurate diagnostic testing.

2) ensure outcome follow up, improved patient care and satisfaction.

3) reduce referrals to Endocrine Clinics hence more capacity for urgent referrals.

4) cost effectiveness.

Prolactin normal reference range: men 86-324 miu/l, women 102-496 miu/l

Reference: 1. Soto-Pedre et al. (2017) https://pubmed.ncbi.nlm.nih.gov/27434534/