Wallach's Interpretation of Diagnostic Tests: Pathways to Arriving at a Clinical Diagnosis (1166 page)

BOOK: Wallach's Interpretation of Diagnostic Tests: Pathways to Arriving at a Clinical Diagnosis
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   Approximately 20% of cases of hypothyroidism (second most common cause of hyperprolactinemia). Therefore, serum TSH and T
4
should always be measured.
   Addison disease
   Polycystic ovaries
   Glucocorticoid excess—normal or moderately elevated prolactin
   Ectopic production of prolactin (e.g., bronchogenic carcinoma, renal cell carcinoma, ovarian teratomas, acute myeloid leukemia)
   Children with sexual precocity—may be increased into pubertal range
   Neurogenic causes (e.g., nursing and breast stimulation, spinal cord lesions, chest wall lesions such as herpes zoster)
   Stress (e.g., surgery, hypoglycemia, vigorous exercise, seizures)
   Pregnancy (increases to 8–20 times normal by delivery, returns to normal 2–4 weeks postpartum unless nursing occurs)
   Lactation
   Chronic renal failure (20–40% of cases; becomes normal after successful renal transplant but not after hemodialysis)
   Liver failure (due to decreased prolactin clearance)
   Idiopathic causes (some probably represent early cases of microadenoma too small to be detected by CT scan)

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