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Masked Hyperprolactinemia in a Case of Aldosterone-Producing Adrenal Adenoma
- Yutaka Oki, MD;
- Toshiko Yagi, MD; and
- Teruga Yoshimi, MD
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TO THE EDITOR:
A 45-year-old woman was admitted to our hospital for evaluation of hypertension. She had never received a dopamine antagonist, histamine-2-receptor antagonist, or oral contraceptive. Laboratory findings showed hypokalemia (potassium level, 2.6 mEq/L). Endocrine data showed that while the patient was supine, her plasma aldosterone concentration and plasma renin activity were 685 pmol/L and 0.1 µg/L·h, respectively. Her plasma renin activity did not increase after the administration of furosemide (40 mg intravenously) and 2 hours of walking. Her serum prolactin level was 18 µg/L. A computed tomographic scan of the abdomen showed a round and solitary tumor (diameter, 2 cm) in the left adrenal gland. Left adrenalectomy was done in response to a diagnosis of aldosterone-producing adrenal adenoma. Figure 1 shows the patient's clinical course before and after surgery. After the surgery, the patient's plasma aldosterone concentration decreased to the normal level, but her serum prolactin level immediately increased to 130 µg/L. Intravenous injection of 500 µg of thyrotropin-releasing hormone increased her serum prolactin level from 80 to 420 µg/L. Her thyroid function was normal. Magnetic resonance image showed no pituitary adenoma and no lesions in the pituitary stalk or hypothalamus. These findings suggested functional hyperprolactinemia. The serum prolactin level remained elevated for 5 weeks, and spontaneous galactorrhea was observed. After bromocriptine was started, the patient's serum prolactin level decreased, and the galactorrhea disappeared.
It is well known that prolactin secretion is under tonic dopamine inhibition [1] and that dopamine inhibits aldosterone secretion [2]. Although the endogenous dopaminergic tone in patients with primary aldosteronism remains controversial [3-5], we speculate that primary aldosteronism increased the systemic dopaminergic tone and that the patient's hyperprolactinemia did not become overt until the surgical treatment of her aldosterone-producing adenoma.
Yutaka Oki, MD
Toshiko Yagi, MD
Teruga Yoshimi, MD
Hamamatsu University School of Medicine; Hamamatsu 431-31, Japan
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
