PSYCHOLOGICAL DISTRESS IN PATIENTS WITH HYPERPROLACTINEMIA

OBJECTIVE In addition to the physical symptoms of galactorrhoea and am enorrhoea, hyperprolactinaemia in women is also reported to be associa ted with psychological symptoms. Previous studies have found an increa sed incidence of depression, anxiety and hostility in female patients with hyperprolactinaemia. In this study, psychological symptoms were a ssessed in a large population of patients and symptom scores were comp ared between patients with definite evidence of pituitary adenoma on h igh-resolution CT scanning and those without, who were presumed to hav e idiopathic or 'functional' hyperprolactinaemia. DESIGN Postal survey : population-control study of female patients with hyperprolactinaemia . PATIENTS Sixty-five women with hyperprolactinaemia were compared wit h a control group of 26 women with normoprolactinaemic pituitary disea se (acromegaly or nonfunctioning pituitary adenoma). The hyperprolacti naemic patients were subdivided according to whether a pituitary adeno ma was visible on high-resolution CT scanning (39 patients) or whether they had normal CT scans, in which case they were categorized as havi ng idiopathic or 'functional' hyperprolactinaemia (26 patients). MEASU REMENTS Patients were sent 2 questionnaires, the Hospital Anxiety and Depression (HAD) Scale and the 90-item Symptom Checklist (SCL-90), to assess psychological wellbeing. RESULTS Overall, 54% of hyperprolactin aemic patients were found to have definite or borderline anxiety as ju dged by HAD scores, compared with 27% of normoprolactinaemic control p atients. Those with normal CT scans were significantly more likely to have definite or borderline anxiety (73% of patients) than those with CT evidence of a pituitary tumour causing their hyperprolactinaemia (4 1%, P < 0.003), despite similar levers of serum prolactin. A similar i ncreased proportion of hyperprolactinaemic patients scored highly on t he anxiety component of the SCL-90, although mean scores were not diff erent from controls. Na differences were seen in scores for depression , but both subgroups of hyperprolactinaemic patients scored more highl y than controls for hostility on the SCL-90 questionnaire. CONCLUSION These findings confirm the presence of significant anxiety in a propor tion of women with hyperprolactinaemia. Hyperprolactinaemic women with no abnormality on CT scans displayed more psychological distress than those with definite pituitary microadenomas. These results may provid e insight into the pathogenesis of 'functional' hyperprolactinaemia.