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Hyperprolactinaemic hypogonadism — SCE Endocrinology MCQ

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ModerateReproductive EndocrinologyHyperprolactinaemic hypogonadismSCE Endocrinology

A 38-year-old man has low libido and fatigue. Morning testosterone is low on two occasions, LH is low, prolactin is 7200 mU/L and MRI shows a 9 mm pituitary adenoma. Visual fields are normal. What is the most appropriate management?

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Correct answer: A — Start dopamine agonist therapy and reassess gonadal axis

Hyperprolactinaemia suppresses GnRH and causes secondary hypogonadism; dopamine agonist therapy treats the cause and may restore testosterone. Testosterone alone would not treat tumour activity or prolactin excess. The pearl is that prolactin should be checked before labelling male hypogonadism as primary.

Reference: Endocrine Society hyperprolactinaemia guideline