目的:分析在初级医疗机构评估的症状与高泌乳素血症相符的患者高泌乳素血症的原因。
方法:一项回顾性研究,对2019年至2020年期间在马德里RamónyCajal医院的20个初级保健中心进行了血清催乳素水平测试。高催乳素血症定义为男性血清催乳素>19.4ng/ml,女性>26.5ng/ml。病因分为生理性(妊娠,哺乳期,静脉穿刺不足,宏观泌乳素血症),药理学,病理性(下丘脑和/或垂体疾病,慢性肾功能衰竭,原发性甲状腺功能减退症),和特发性。
结果:在1630名患者中检测血清催乳素,30.7%(n=501)患有高催乳素血症。在这501名患者中,89.6%为女性。149例患者转诊至内分泌科,164例转诊至妇科。501例中有411例获得了高泌乳素血症的病因诊断。高催乳素血症最常见的原因是药理学,在39.1%。第二个更常见的原因是特发性(29%),不太常见的是静脉穿刺拔除不足(13.4%),肿瘤(8.5%)和大型泌乳素血症(3.9%)。肿瘤性高泌乳素血症患者的血清催乳素水平较高(87.0±80.19vs49.7±39.62ng/ml,P=0.010)。此外,症状,例如半乳糖(33.3%vs16.5%,P=0.018),和头痛(25.7%vs13.3%,P=0.045),比其他病因组的患者更常见。
结论:高催乳素血症在初级护理环境中被评估为高催乳素血症症状的患者中很常见,但超过50%的病例是由于药物治疗或样品提取不当。有必要建立专门医学的转诊协议,以优化医疗保健资源并避免不必要的研究。
OBJECTIVE: To analyse the causes of hyperprolactinaemia in patients with symptoms compatible with hyperprolactinaemia evaluated in a primary care setting.
METHODS: A retrospective study of all patients tested for serum prolactin levels between 2019 and 2020 in 20 primary care centres at the Hospital Ramón y Cajal in Madrid. Hyperprolactinaemia is defined as a serum prolactin>19.4ng/ml in men and >26.5ng/ml in women. Aetiology is grouped into physiological (pregnancy, lactation, inadequate venipuncture, macroprolactinaemia), pharmacological, pathological (hypothalamic and/or pituitary diseases, chronic renal failure, primary hypothyroidism), and idiopathic.
RESULTS: In 1630 patients tested for serum prolactin, 30.7% (n=501) had hyperprolactinaemia. Of these 501 patients, 89.6% were females. 149 patients were referred to the Endocrinology Department and 164 to the Gynaecology Department. Aetiological diagnosis of hyperprolactinaemia was achieved in 411 out of 501 cases. The most frequent cause of hyperprolactinaemia was pharmacological, in 39.1%. The second more frequent cause was idiopathic (29%) and less common were inadequate venipuncture extraction (13.4%), tumour (8.5%) and macroprolactinaemia (3.9%). Patients with tumoural hyperprolactinaemia presented higher serum prolactin levels (87.0±80.19 vs 49.7±39.62ng/ml, P=0.010). In addition, symptoms, such as galactorrhoea (33.3% vs 16.5%, P=0.018), and headache (25.7% vs 13.3%, P=0.045), were more frequent than in patients of the other aetiological groups.
CONCLUSIONS: Hyperprolactinaemia is common among patients evaluated in a primary care setting with symptoms of hyperprolactinaemia, but more than 50% of cases are due to pharmacological treatments or improper sample extraction. It is necessary to establish referral protocols to specialised medicine to optimise healthcare resources and avoid unnecessary studies.