Hyperprolactinemia in Young Females with Questionable Lesion in Sellar Imaging: Indication for Surgery?

Background: Hyperprolactinemia is a common cause of menstrual disturbances affecting young women. There is a diversity of causes. Identifying the correct cause is important to establish the correct treatment. Therefore, we retrospectively investigated young females assigned to our department because of hyperprolactinemia and questionable intrasellar lesions. Methods: We analyzed our databank concerning hyperprolactinemia and age less than 40 years. Patients’ history, medication, blood investigations, MR sellar imaging, and ophthalmological diagnostics were performed. All patients were endocrinologically checked by specialized consultants and assigned to our neurosurgical department for evaluation to surgery. Results: Overall 31 females out of 109 patients younger than 40 years with suspicious pituitary microadenomas had a mild hyperprolactinemia and questionable suspected microadenomas in sellar imaging. Main reason for mild hyperprolactinemia was antipsychotic medication and other pharmacological causes. Further, MR imaging with dynamic measurement of pituitary contrast enhancement was performed as follow-up controls and revealed no pituitary pathology. Conclusion: In symptomatic patients, treatment with dopaminergic agonists is indicated, but not for explorative surgery. In case of asymptomatic hyperprolactinemia, macroprolactinemia should be screened, and once it is detected, there is no need for pituitary imaging study or for dopaminergic agonist use as alternative treatment.