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Prolactinoma and Ménière's disease

 

Clinical bottom line

Hyperprolactinaemia was found preoperatively in 14/42 patients with Ménière's disease, and in six who were investigated prolactinoma was found. Systematic determination of prolactin might be sensible before opting for surgery until these findings are confirmed.


Reference

KC Horner et al. Prolactinoma in some Ménière's patients - is stress involved? Neuropsychopharmacology 2002 26: 135-138.

Methods

Over two years patients with Ménière's disease in Marseille undergoing surgery for incapacitating vertigo were recruited. Before surgery a final audiogram was done and vestibular performance tested. A blood sample was taken on the morning before surgery. Because hormone levels can be affected by stress, controls were patients also undergoing surgery in the same institution for acoustic neuroma ort facial spasm. No patient was taking drugs.

Results

In the 30 control subjects, almost all the prolactin levels were below, at, or slightly above the upper limit of normal for the referring laboratory. For the patients with Ménière's disease, raised values, as high as 20 times the upper limit of normal, were found in 14 of 42 patients.

Six of the 14 patients with elevated prolactin were investigated for prolactinoma, and this was confirmed in all six.

Comment

In this small sample the presence of prolactinoma was about 50-100 times more common than in an unselected population. It would make it sensible to check for elevated prolactin in patients with known or suspected Ménière's disease.

What we do not know is what the connection is, and whether treating the prolactinoma improves the symptoms of Ménière's disease.