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| COMMENTARY |
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| Year : 2019 | Volume
: 12
| Issue : 3 | Page : 225-226 |
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Hyperprolactinemia and hypothyroidism
Viroj Wiwanitkit
Department of Community Medicine, Dr. DY Patil Vidyapeeth, Pune, Maharashtra, India; Department of Biological Science, Joseph Ayo Babalola University, Ilara-Mokin, Nigeria; Department of Medical Science, Faculty of Medicine, University of Nis, Nis, Serbia
| Date of Web Publication | 15-May-2019 |
Correspondence Address:
Viroj Wiwanitkit
Dr. DY Patil University, Pune, Maharashtra
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/mjdrdypu.mjdrdypu_179_18
How to cite this article:
Wiwanitkit V. Hyperprolactinemia and hypothyroidism. Med J DY Patil Vidyapeeth 2019;12:225-6 |
The study on the prolactin hormone profile in a patient with hypothyroidism is an interesting observation in clinical endocrinology.[1] It is concluded and suggested that serum prolactin levels should be assessed in all hypothyroid females due to the high incidence of hyperprolactinemia among this population.[1] In fact, both thyroid function test and prolactin are important hormone tests in clinical pathology. In fact, the relationship between thyroid and prolactin is an important topic that is widely studied in clinical endocrinology research. In a recent study, thyroid volume was proven to be not related to serum prolactin level, but there was a high thyroid volume in the female with prolactinoma comparing to normal female.[2] The biochemical association between hyperprolactinemia and hypothyroidism in a woman is reported.[3] Sharma et al. found that “a high incidence of hyperprolactinemia was found in infertile women and a positive correlation was found between hyperprolactinemia and hypothyroidism.[3]” There are many case reports of galactorrhea in the cases with hypothyroidism. However, the normal prolactin level might be observed in some cases with galactorrhea including the case of mild hypothyroidism, leading to galactorrhea.[4] On the other hand, the clinically euthyroid case with galactorrhea might have the abnormal thyroid function identified by clinical laboratory test.[4] As concluded by Aziz et al., hyperprolactinemia is a common problem in primary hypothyroidism including subclinical hypothyroidism.[5] Aziz et al. also noted that both thyroid function test and prolactin level could return normal if the thyroxin therapy was applied.[5] Hence, it can confirm that increased levels of thyrotropin-releasing hormone in hypothyroidism can result in increased prolactin level. Pathophysiologically, primary hypothyroidism might induce hyperprolactinemia, and prolonged disorder might further result in pituitary hyperplasia.
The interesting consideration is the additional test for rooted cause analysis of the case with concurrent hyperprolactinemia and hypothyroidism. Many medications can result in hyperprolactinemia and hypothyroidism; hence, the practitioners have to carefully review the history of medication of the patients with abnormal hormone profile. Of interest, some uncommon drugs are also reported for the possible relationship with concurrent hyperprolactinemia and hypothyroidism. The good example is isoniazid, which is a commonly used drug for the treatment of tuberculosis.[5] In addition, some uncommon endocrine pathology can also result in concurrent hyperprolactinemia and hypothyroidism. The good example is pituitary carcinoma.[6] In a recent report by Bettencourt-Silva et al., a patient with prolactin-producing pituitary carcinoma was reported for an interesting, complex clinical problem that includes concurrent hyperprolactinemia and hypothyroidism, amenorrhea, and hemianopsia.[6] In some rare case, the pituitary pathology might be due to tuberculosis.[7] Since tuberculosis is still the public health problem worldwide, the rare pituitary tuberculosis should also be included in the differential diagnosis for concurrent hyperprolactinemia and hypothyroidism.
Nevertheless, the pathological process might be due to more than one complex problem but two isolated problems. There is a chance that there might be the pathological disorders at both thyroid and pituitary gland that can cause concurrent hyperprolactinemia and hypothyroidism. The good example is the concurrent hyperprolactinemia and hypothyroidism seen in the patient with both hypothyroidism secondary to autoimmune thyroiditis and hyperprolactinemia due to pituitary microadenoma.[8],[9] Khorassanizadeh et al. noted that “a marked elevation of prolactin should raise suspicion to investigate additional etiologies for hyperprolactinemia.[9]” An important point to aware is that a finding of both hypothyroidism and pituitary mass in a patient with concurrent hyperprolactinemia and hypothyroidism can be either the separated two pathological disorders or a complex pathology of a single pathological problem, pituitary hyperplasia due to prolonged hypothyroidism. To avoid unnecessary surgery, the use of levothyroxine therapy can help differentiate the two mentioned conditions. A dramatic response is usually observed within few months after of levothyroxine therapy if the problem is pituitary hyperplasia due to prolonged hypothyroidism.[10]
Finally, there is an interesting rare syndrome namely Van-Wyk-Grumbach syndrome. In this syndrome, the patient has concurrent hyperprolactinemia and hypothyroidism with additional problems including precocious puberty, secondary amenorrhea, and galactorrhea. The patient might have ovarian cysts that can clinically present as an abdominal mass.[11]
| References | |  |
| 1. | Koner S, Chaudhuri A, Biswas A, Adhya D, Ray R. A study on thyroid profile and prolactin level in hypothyroid females of a rural population of a developing country. Med J Dr DY Patil Univ 2019;12:217-24.  |
| 2. | Doǧan BA, Taşcı T, Arduç A, Müslüm Tuna M, Berker D, Güler S, et al. Are there any causes for increased thyroid volume in women with prolactinoma? Ann Endocrinol (Paris) 2015;76:595-600. |
| 3. | Sharma N, Baliarsingh S, Kaushik GG. Biochemical association of hyperprolactinemia with hypothyroidism in infertile women. Clin Lab 2012;58:805-10. |
| 4. | Patrascu OM, Chopra D, Dwivedi S. Galactorrhoea: Report of two cases. Maedica (Buchar) 2015;10:136-9. |
| 5. | Aziz K, Shahbaz A, Umair M, Sharifzadeh M, Sachmechi I. Hyperprolactinemia with galactorrhea due to subclinical hypothyroidism: A Case report and review of literature. Cureus 2018;10:e2723. |
| 6. | Bettencourt-Silva R, Pereira J, Belo S, Magalhães D, Queirós J, Carvalho D, et al. Prolactin-producing pituitary carcinoma, hypopituitarism, and Graves' disease-report of a challenging case and literature review. Front Endocrinol (Lausanne) 2018;9:312. |
| 7. | Majumdar K, Barnard M, Ramachandra S, Berovic M, Powell M. Tuberculosis in the pituitary fossa: A common pathology in an uncommon site. Endocrinol Diabetes Metab Case Rep 2014;2014:140091. |
| 8. | Chafik A, El Mghari G, El Ansari N. Hyperprolactinemia: Unusual association between peripheral hypothyroidism and microprolactinoma. Pan Afr Med J 2016;24:41. |
| 9. | Khorassanizadeh R, Sundaresh V, Levine SN. Primary hypothyroidism with exceptionally high prolactin-A really big deal. World Neurosurg 2016;91:675.e11-4. |
| 10. | Rajput R, Sehgal A, Gahlan D. Reversible thyrotroph hyperplasia with hyperprolactinemia: A rare presenting manifestation of primary hypothyroidism. Indian J Endocrinol Metab 2012;16:1037-9. |
| 11. | Shivaprasad KS, Dutta D, Jain R, Kumar M, Maisnam I, Biswas D, et al. Huge bilateral ovarian cysts in adulthood as the presenting feature of Van Wyk Grumbach syndrome due to chronic uncontrolled juvenile hypothyroidism. Indian J Endocrinol Metab 2013;17:S164-6. |
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