A case of a 13 year old girl who manifested hyperprolactinaemia and galactorrhea induced by Omeprazole, a commonly used proton pump inhibitor is presented

Farrukh, Syed Nadir

Jabbar, Abdul

Khan, Rabbia

eCommons@AKU

eCommons@AKUSection of Internal Medicine Department of MedicineAugust 2010Hyperprolactinaemia induced by proton pumpinhibitorAbdul JabbarAga Khan UniversityRabbia KhanAga Khan UniversitySyed Nadir FarrukhAga Khan UniversityFollow this and additional works at: http://ecommons.aku.edu/pakistan_fhs_mc_med_intern_medPart of the Nervous System Diseases CommonsRecommended CitationJabbar, A., Khan, R., Farrukh, S. (2010). Hyperprolactinaemia induced by proton pump inhibitor. Journal of the Pakistan MedicalAssociation, 60(8), 689-90.Available at: http://ecommons.aku.edu/pakistan_fhs_mc_med_intern_med/15AbstractA case of a 13 year old girl who manifestedhyperprolactinaemia and galactorrhea induced by Omeprazole,a commonly used proton pump inhibitor is presented.IntroductionHyperprolactinaemia is a condition of elevated serumprolactin levels, manifesting as galactorrhoea and menstrualirregularities in women and erectile dysfunction and decreasedlibido in men. Hyperprolactinaemia has a long list of causesincluding physiological, pathological and pharmacological.1,2Drug induced hyperprolactinaemia is common and a numberof drugs have been identified as the cause. e.g.antiphsychotics, antidepressants, H2 receptor antagonist,antiandrogens, estrogen, prokinetics, anticonvulsants, opiatesand cholinomimetics. These drugs raise the serum prolactin toa level that is frequently associated with symptoms.1-5We describe here a case of hyperprolactinaemiapresenting with galactorrhea induced by Omeprazole (losec) aproton pump inhibitor.This to our knowledge has not been reported before.Case ReportA 13 year old girl presented to her physician with ahistory of migranous headache and was prescribed mefenamicacid. Other than these bouts of headache for last 3 months, shehad no active medical issues. On taking mefenamic acid shedeveloped dyspeptic symptoms and was found helicobacterantibody positive and was prescribed Omeprazole. After 4days of treatment with Omeprazole 20mg BD, she developedbilateral galactorrhea. Her prolactin level was found to be288ng/ml (normal being 2.7-22.4ng/ml). On detailedinterrogation she refused to have taken any other drugs inparticular antiemetics or H2 receptor antagonists. An MRI ofhypothalamo-pituitary area revealed a bulky pituitaryprobably due to pubertal change. She was given a course ofanti helicobacter regimen and Omeprazole was discontinued.The galactorrhea resolved and three weeks later her serumprolactin levels returned to 17.5ng/ml (normal).Considering the temporal relationship withomeprazole, with the patient and parent's consent, she wasrechallenged with omeprazole after six weeks and her serumprolactin level was checked again. The serum prolactin levelwas increased from a base line of 26.6 to 70ng/ml and returnedback to normal in 2 weeks after withdrawal.As part of laboratory work up, serum calcium,phosphorus, gastrin was reported normal.Later, she reported with a bout of headache to someother centre and was given injection Domperidone and tabletsfor nausea as take home medication. Forty eight hours latershe again developed galactorrhea and her domperidone wasdiscontinued. This time her prolactin level was 161ng/ml. Sheremained normal with episodes of headache and nausea,which used to settle with acetaminophen and NSAID,alongwith antacids, sucralfate and ranitidine which wastolerated well.After about six months she again developed a severebout of headache with nausea, vomiting and dizziness andattended a nearby medical centre where she was giveninjection diclofenac. On insistence by her parents about thepast medical history of galactorrhea induced by omeprazole(losec), this time she was prescribed lansoprazole instead ofomeprazole. Three days later she again developedgalactorrhea and her serum prolactin was 49.7ng/ml whichreturned to normal in a week after stopping lansoprazole.These three documented instances ofhyperprolactinemia by proton pump inhibitors is to ourknowledge, has not been reported before.DiscussionHyperprolactinemia, a very common biochemicalabnormality, is frequently associated with the use of certainmedications. There is a long list of medications that areassociated with a rise in serum prolactin and symptoms ofhyperprolactinemia.1-5Hyperprolactinemia induced by medication shouldreturn to normal after the withdrawal of the offending drug. Inthis case the administration of proton pump inhibitor provokeda rise in serum prolactin level, followed by a return towardsthe baseline after its discontinuation. Although proton pumpinhibitors are generally well tolerated and they are the mostcommonly prescribed classes of medication in the treatment ofacid peptic disease,6 an important adverse effect is a rise inserum prolactin level.To our knowledge this is the first case reportincriminating the proton pump inhibitors as a cause ofsymptomatic hyperprolactinemia. HyperprolactinemiaVol. 60, No. 8, August 2010 689Case ReportHyperprolactinaemia induced by proton pump inhibitorAbdul Jabbar, Rabbia Khan, Syed Nadir FarrukhDepartment of Medicine, Aga Khan University Hospital, Karachi, Pakistan.induced by medication does not need to be managed withdopamine agonists like cabergoline or bromocriptine, as inthe case of hyperprolactinemia caused by somepathological cause.1References1. Molitch ME. Medication induced hyperprolactinaemia. Mayo Clin Proc 2005;80: 1050-7. 2. David, SR, Taylor, CC, Kinon, BJ, Breier, A. The effects of olanzapine,rispiridone, and haloperiodol on plasma prolactin levels in patients withschizophrenia. Clin Ther 2000; 22:1085-96. 3. Torre DL, Falorni A. Pharmacological causes of hyperprolactinaemia. Ther ClinRisk Manag 2007; 3: 929-51.4. Bandyopadhyay P Drug induced hyperprolactinaemia. Timely Top MedCardiovasc Dis 2006; 10: E14.5. Rivera JL, Lal S, Ettigi P, Hontela S, Muller HF, Friesen HG. Effect of acute andchronic neuroleptic therapy on serum prolactin levels in men and women ofdifferent age groups. Clin Endocrinol (Oxf) 1976; 5: 273-82. 6. Coté GA, Howden CW. Potential adverse effect of proton pump inhibitors. CurrGastroenterol Rep 2008; 10: 208-14.690 J Pak Med Assoc

Hyperprolactinaemia induced by proton pump inhibitor

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Hyperprolactinaemia induced by proton pump inhibitor

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