Searches were carried out in July 2010. Relevant articles in English language are cited in this review and reflect a personal selection of the author. Clinical symptoms result from endocrine effects of hyperprolactinaemia and from mass effects owing to tumour expansion. Prolactin induces galactorrhoea and hypogonadotropic hypogonadism owing to an inhibitory effect on hypothalamic GnRH release. Thus, in children, primary hypogonadism and delayed puberty will be observed PLX-4720
[6,11], and in premenopausal women, secondary oligo- or amenorrhoea. In children and adolescents, macroadenomas are more frequent in men, and tumours are diagnosed later with a higher incidence of headache and vision impairment, growth arrest and other pituitary disturbances when compared to women. In the reproductive age, hyperprolactinaemia in men causes impotence, infertility and loss of libido. Whereas the typical complex of galactorrhoea and amenorrhoea usually will result in prompt medical consultation by female patients, the more subtle complex of decreased libido and erectile dysfunction may delay diagnostic procedures in adult men . In female patients, most prolactinomas are microadenomas with a diameter <10?mm, whereas <a href="http://www.selleckchem.com/products/eai045.html
">EAI045 male patients present later in life and with larger tumours . In postmenopausal women, the classical features are not present and symptoms are related to mass effects, such as visual loss and headache, but oestrogen replacement may allow galactorrhoea also in postmenopausal patients. Mass effects of larger tumours include compression of pituitary cells or pituitary stalk resulting in additional defects of pituitary functions and/or neurological symptoms (Table?3). Long-term hypogonadism may lead to reduced bone mass [14,15]. The diagnosis of hyperprolactinaemia and prolactinoma requires careful clinical evaluation, laboratory testing and pituitary imaging techniques. At first, physiological causes of prolactin elevation need to be ruled out by clinical history and examination (Table?1). If the patient is taking a drug, known to increase prolactin levels (Table?2), A1331852
the candidate drug should be discontinued if possible or replaced by an alternative drug, which does not increase prolactin secretion. Prolactin levels should be remeasured after 72?h . The initial laboratory testing should include a pregnancy test, routine biochemical parameters to exclude renal or hepatic insufficiency and TSH determination. Excessive stress should be avoided, and the patient should be awake and fasted for at least 1?h . Normal prolactin levels in women are below 20�C25?��g?L?1 and below 15�C20?��g?L?1 in men with the commonly used assays (1?��g?L?1 is equivalent to 21��2?mIU?L?1).