Amenorrhea, Hyperprolactinemia, and Pituitary Enlargement Secondary to Primary Hypothyroidism

Keye, William R.; Yuen, Basil Ho; Knopf, Ralph F.; Jaffe, Robert B.

doi:10.1097/00006254-197705000-00020

Cited by 14 publications

(22 citation statements)

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“…The association of amenorrhea, hyperprolactinemia, and hypothyroidism is well known [16][17][18]. Keye et al [19] had reported a case of amenorrhea, hyperprolactinemia, and pituitary en largement secondary to primary hypothyroidism. Their patient also responded to thyroid replacement.…”

Section: Discussionmentioning

confidence: 99%

Hyperiodotyrosinemia-Induced Hyperprolactinemia and Hyperaldosteronism

Tan¹,

Tan²

1990

Horm Res

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A 21-year-old goitrous hypothyroid Chinese woman had elevated serum iodotyrosines with a monoiodotyrosine level of 85.9 nmol/l (normal 0.49–0.89 nmol/l) and a diiodotyrosine level of 25.3 nmol/l (normal 0.023–0.53 nmol/l). She was amenorrheic with low luteinizing hormone and follicle-stimulating hormone levels at 5.8 and 2.8 U/l, respectively. The hypogonadotropic hypogonadism was due to an elevated prolactin level of 8.8 nmol/l. She also had a low potassium level of 3.2 mmol/l, and a high urinary aldosterone level of 158 nmol/day. The hyperprolactinemia, hypogonadotropic hypogonadism, hyperaldosteronism and hypokalemia subsided with the administration of bromocriptine 5 mg/day. However, bromocriptine accentuated the hyperiodotyrosinemia, and the patient remained hypothyroid. Levothyroxine therapy lowered the monoiodotyrosine and diiodotyrosine levels, ameliorated all her endocrinopathies, started her periods, and shrank the goiter. She probably had a deiodinase defect which permitted the discharge of accumulated iodotyrosines from the thyroid gland. Since iodotyrosines are tyrosine hydroxylase inhibitors, the hyperiodotyrosinemia causes dopamine synthesis inhibition, and induces the hyperprolactinemia and hyperaldosteronism.

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Section: Discussionmentioning

confidence: 99%

Hyperiodotyrosinemia-Induced Hyperprolactinemia and Hyperaldosteronism

Tan¹,

Tan²

1990

Horm Res

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“…Primary hypothyroidism is the common endocrine disorder associated with raised prolactin levels (30). These patients may present with galactorrhoeaamenorrhoea and radiographic evidence of a n enlarged pituitary fossa suggestive of the presence of a prolactinoma (31,32). The dual effect of thyrotropin releasing hormone (TRH) on the pituitary thyrotrophes and lactrophes had been suggested as the mechanism for the concurrent elevation of thyroid stimulating hormone (TSH) and prolactin (33)(34)(35).…”

Section: Discussionmentioning

confidence: 99%

Hyperprolactinaemic Amenorrhoea in Hong Kong

Tang

Sung

1983

Aust NZ J Obst Gynaeco

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In a retrospective study of 595 patients attending the Menstrual Disorder Clinic from January, 1978 to December, 1981, 92 patients (15.5%) had raised serum prolactin (PRL) levels (greater than 25 ng/ml) on 2 or more separate occasions with a mean (+/- S.E.M.) value of 67.1 +/- 2.5 ng/ml. Galactorrhoea was found in 27.2% of the hyperprolactinaemic patients. Primary amenorrhoea was observed in 1 patient (1.1%) with serum PRL level of 68 ng/ml. Secondary amenorrhoea of longer than 6 months' duration occurred in 61 patients (66.3%) with mean PRL level 84.2 +/- 3.3 ng/ml. The 30 patients (32.6%) with irregular menstruation had a mean PRL level of 47.2 +/- 3.3 ng/ml. Investigations revealed that 43 patients (46.7%) had idiopathic hyperprolactinaemia, 14 patients (15.4%) had drug induced hyperprolactinaemia and 1 patient (1.1%) had hypothyroidism; 18 patients (19.5%) had suspected pituitary microadenoma and 16 patients (17.2%) had abnormal radiographic findings. Bromocriptine treatment was given to 38 patients, 13 with abnormal tomographic findings (mean serum PRL greater than 100ng/ml); 18 with suspected pituitary microadenoma (mean serum PRL 94 +/- 2.7 ng/ml) and 7 with idiopathic hyperprolactinaemia (mean serum PRL 65 +/- 4.7 ng/ml). All patients (38/38) responded to treatment with restoration of menstruation and cessation of galactorrhoea within 1 to 3 months. Mean PRL level was 21.6 +/- 5.2 ng/ml at the time of response. Thirteen patients subsequently became pregnant and all delivered healthy babies.

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“…Така ГП може бути компенсована призна-ченням левотироксина як замісної терапії при гіпотиреозі [23,24].…”

Section: етіологіяunclassified

“…Частота ГП при маніфест-ному гіпотиреозі становить 21-35% випадків, при субклі-нічному -8-22%. На фоні призначення адекватних доз тиреоїдних гормонів (левотироксину) відзначається досяг-нення не тільки еутиреозу, але і нормопролактинемії, тому при підтвердженні гіпотиреозу питання про подальше лі-кування ГП необхідно вирішувати тільки після нормалізації рівня тиреотропного гормону [22][23][24]. Однак лікування ти-реоїдними гормонами не завжди призводить до зниження рівня пролактину, відновлення менструальної функції та овуляції, зникнення галактореї, тому в таких пацієнток слід розглянути питання про доцільність паралельного прове-дення терапії агоністами дофаміну [74].…”

Section: інші методи обстеження при гпunclassified