Hyperprolactinemia

The woman discussed in this exercise has the galactorrhea-amenorrhea syndrome with elevated serum prolactin levels. Roentgenographic study showed an intrasellar tumor with suprasellar extension that ordinarily would have permitted the diagnosis of prolactinoma but for the finding of hyperostosis of the sphenoid bone, which aroused suspicion that she might have a meningioma causing prolactin excess and gonadotropin failure by destruction of the pituitary stalk. The patient underwent an extensive series of tests of prolactin secretory reserve in an attempt to elucidate the diagnosis, as well as cerebral arteriography. The discussion of disease illuminates the pathogenesis of prolactinoma, describes and puts in perspective physiological tests of prolactin secretion and their application to differential diagnosis of sellar and parasellar lesions, and summarizes the current knowledge of the mechanisms of regulation of prolactin secretion.