The limits of our study are of four kinds:

The small size of our sample did not allow for a multivariate statistical analysis.The fact that certain examinations useful for the etiological diagnosis could not be carried out in some patients, in particular pituitary MRI, which would have made it possible to differentiate the central causes (hypothalomo-pituitary) from the other causes of hyperprolactinemia.Discontinuation or abandonment of treatment for social and/or financial problems after one year of treatment for every three patients.The fact that our protocol did not take into account hyperprolactinic drugs and other factors

During our study, we obtained a frequency of 0.82% out of 5187 new consultations. This frequency cannot be compared to that of other authors such as Mahamane Sani MA in Niger, M Mariko in the endocrinology department of the Mali hospital and that of Soto-PedreE in Scotland [5]-[7] because their sampling was on both men and women. In our study, the sampling was female and particularly on women of childbearing age. But all these authors reported a female predominance, as evidenced by the study by Mahamane Sani MA [5] 81.6%; Nguenan M [8] 83.30%, M Mariko [6] 54.05%. This female predominance is known in the literature, it had been reported by several studies including, among others; Nguenan M [6] with 83.30%. For these authors, this clear female predominance could be explained by the fact that the clinical symptomatology is richer in women than in men and that women were more active in consultations than men [5]-[8].

The mean age of our patients was 28.33 years with extremes between 17 and 44 years. In the series by M Mariko etal., the female predominance was 54% with the mean age of 37.32 years as reported by Essais O etal. [9]. The ages in our series were not juxtaposable with those of other authors, as they only focused their studies on the general population, whereas ours only focused on patients of childbearing age. This is why in the series of Mahamane Sani MA etal. [5], the age of the patients varied between 4 and 58 years, with an average age of 33.5 years; and the age group of 21 to 31 years was the most represented with 42.10%. The Mahamane Sani MA study [5] was similar to that of the others such as Essais O etal. [9] in Tunisia in 2002, Azeroual M [10] in Morocco in 2012, N’Guessan K etal. [11] in Côte d’Ivoire in 2003 and Nguenam M [8] and M Mariko et [6] in Mali in 2004 which found 33 years, 33 years, 33 years and 31.6 years respectively.

The desire to become pregnant was the most frequent reason at 79.06% in our series. This rate is higher than those reported by the series of Mahamane Sani MA etal. [5]; Mariko M etal. [6] which reported 41.93% and 50% respectively. The amenorrhea-galactorrhea combination concerned 46.5% of our patients followed by cycle disorders with 41.8%. This rate was lower than that reported by Mahamane Sani MA [5] 74.19% for the same amenorrhea-galactorrhea combination and 32.25% for cycle disorders, pelvic headaches 4.7%. M Mariko etal. [6] reported higher rates, 80% amenorrhea and 70% galactorrhea, a result comparable to those of Lemaire C [12]. Neurological signs in our series (nervousness, headache, visual disturbances) were found in 18.6% of patients, while M Mariko etal. [6] reported a higher rate of 55%. We noted that 27.9% were asymptomatic, but authors such as Mahamane Sani MA [5], Nguenam M [8], and N’Guessan K, etal. [11] did not report asymptomatic hyperprolactinemia.

In our series, female infertility was primary in 65.1%. Mahamane Sani MA [5], and M Mariko etal. [6] reported lower rates of 41.93% and 50% respectively. Authors such as Nguenam M [8], N’Guessan K [11] did not mention female infertility in their series. Mayanda Ohouana RL etal. [13], in Brazzaville and M. Elleuch [14] in Tunisia had only collected cases of prolactinomas in their series. Compared to hyperprolactinemic factors such as estrogen-progestogen-based contraceptives, only 23.25% of our patients had observed this method and we had not looked for drug or environmental factors, especially stress. Mahamane Sani MA etal. [5] reported 28.94% drug etiology and 5.26% nipple sucking, while M Mariko etal. [6] showed 5.40% estrogen-progestin use by patients in their series of estrogen-progestogen use. There is an established link between estrogen-progestin intake, increased prolactin secretion, and lactotropic cell hyperplasia [15].

In our study, the mean prolactinemia value was 140.95 ng/mml with extremes of 28 to 500 ng/ml. This result is lower than that of N’Guessan K [11] who reported 848.96 ng/ml and that of Mayanda O [13] who had noted an average of 321.86 ng with extremes between 64.91 and 900 ng. The mean level of prolactinemia in our study was between 25 and 100 ng/mml in 53.5% of cases and 34.9% of patients had a prolactin level greater than 200 ng/mml. In the Mahamane Sani MA etal. series [5], the mean prolactinemia rate was 166.18 ng with extremes ranging from 25.43 to 3344 ng/ml. In the same Nigerien series, it was between 20 and 100 ng/ml in 73.67% of patients.

We found 23.25% of pituitary macroadenomas for prolactin values above 200 ng/mml. This result was comparable to that of M Mariko etal., who reported 27.02% for prolactinemia greater than 200 ng/ml. We recall that our inclusion criteria only concerned patients of childbearing age. Authors such as M. Elleuch [14] in Tunisia and Mayanda O [13] only had cases of pituitary prolactinomas.

The reference morphological examination in the etiological diagnosis of hyperprolactinemia remains the pituitary MRI (Gold standard). It is difficult to access in our developing countries because of the high cost, which is why no patient in the series has undergone this examination.

The pelvic ultrasound of our patients had objectified 20.93% of cystic dystrophies of the ovaries and a uterine myomatous in 7%. In the series of Mahamane Sani MA etal. [5], it was performed in 65.78% of patients and did not objectify any particularity.

Other disturbances in the hypothalomo-pituitary hormones of our patients were as follows: AMH (34.8%); FHS (2.3%); estradiol (4.7%). We report that LH was not requested in 44.2% of patients. In the others, the assessment of other hormones in the hypothalomo-pituitary axis [5][6][11][13] was not taken into account.

In our series, the treatment was mainly medical for all our patients. The same was true for the series by Mahamane Sani MA etal. [5] in Niger and Mayanda O [13] in Brazzaville. These results are different from those of Trials O. etal. [9] and Seck M [16] which reported t 86.20% and 66.66% respectively. This difference could be explained by the effectiveness of medical treatments on the one hand and by the unavailability of surgical treatments in our regions.

The medical treatment of our patients was done with dopaminergic agonists, in particular cabergoline in 81.4% of patients and bromocriptine in 18.6%. Our data are slightly different from those of Mahamane Sani MA [5], M Mariko [6] who had prescribed cabergoline in 65.8% and 64.9% of cases respectively and bromocriptine in 34.2% and 27%. According to authors such as Colao A and Di Sarno A, cabergoline is the hypoprolactinemic agent that has fewer side effects and is therefore better tolerated than other dopaminergic agonists [17][18].

Clinical improvement was obtained in 23.3% of our patients after one month; 37.2% after 3 months; 20.9% after six months; 9.5% at nine months and 5% at one year.

Mahamane Sani MA [5] stated that the course of treatment at 10 months on average was favorable in 89.47% of patients and a persistence of signs in 10.52% of patients, while Seck M [16] reported a favorable evolution at 8 months on average in 33.33% of patients and a persistence of signs in 50% of cases. We did not note cases of treatment failure, only that 6.8% of our patients abandoned treatment for social problems. We noted a statistically significant relationship between the rate of prolactinemia and clinical signs (P < 0.05).

Pregnancy was contracted in 39.53% of our patients. The mean interval between the start of treatment and the onset of pregnancy was 3 to 4 months in 66.6% of cases; between 6 and 9 months 23.4%. The others, such as Mahamane Sani MA [5], M Mariko [6], N’guessan K.B [11] did not appreciate the fertility after treatment of hyperprolactinemia.