Review Article

Hyperprolactinemia: A Systematic Review of Diagnosis and Management

Nazma Akter1, Nazmul Kabir Qureshi2, Tangera Akter3

Abstract
Hyperprolactinemia is a common endocrine disorder that can be associated with
significant morbidity. It can result from a number of causes, including use of medication,
hypothyroidism and pituitary disorders. Depending on the cause and consequences of
hyperprolactinemia, selected patients require treatment considering the underlying
cause, age sex, and reproductive status. We describe a systematic review of
hyperprolactinemia, including microadenomas and macroadenomas, in various clinical
settings, with emphasis on newer diagnostic strategies and the role of various
therapeutic options, including treatment with selective dopamine agonists. Through this
review, we aimed to compare efficacy and adverse effects of medications, surgery and
radiotherapy in the treatment of hyperprolactinemia.
Keywords: Hyperprolactinemia; diagnostic strategies; therapeutic options.

Delta Med Col J. Jul 2018;6(2): 90 – 101

Search strategy Introduction

We searched electronic databases, reviewed Prolactin is a pituitary-derived hormone that plays
bibliographies of included articles and sought a pivotal role in a variety of reproductive
articles addressing hyperprolactinemia or functions. It is an essential factor for normal
prolactin-secreting tumours that were treated by production of breast milk following childbirth.
dopamine agonists, surgery or radiotherapy, and Furthermore, prolactin negatively modulates the
which focused on outcomes from those secretion of pituitary hormones responsible for
treatments. We searched in MEDLINE, The New gonadal function, including luteinizing hormone
England Journal of Medicine, Bio Med Central and follicle-stimulating hormone. An excess of
Journal and Pub Med from March 2016 to June prolactin, or hyperprolactinemia, is a commonly
2016. Search was limited to articles published encountered clinical condition.1 It is the most
in English. common disorder of the hypothalamic-pituitary

1. Resident Physician & Consultant, Dept. of Endocrinology & Metabolism, MARKS Medical College & Hospital, Dhaka,
Bangladesh.
2. FACE Consultant, Dept. of Endocrinology & Medicine, National Health Care Network (NHN), DAB, Bangladesh.
3. Assistant Professor (C.C.), Dept. of Surgery, Delta Medical College, Dhaka, Bangladesh.
Correspondence: Dr. Nazma Akter. e-mail: nazma_aktar_endo@yahoo.com

90 Delta Med Col J. Jul 2018;6(2)

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axis. Patients typically present with galactorrhea or infertility, and men with
hypogonadism, infertility or, in the case of hypogonadism, impotence or infertility must have
macroadenomas, symptoms related to mass effect serum prolactin levels measured.1 It is estimated at
(headache and visual field defects). Management 9% among women with amenorrhea, 17% among
of this condition depends on the cause and on the women with polycystic ovary syndrome, 25%
effects it has on the patient. Commonly cited among women with galactorrhea and as high as
indications for treatment of microprolactinomas 70% among women with amenorrhea and
include infertility, hypogonadism, prevention of galactorrhea.2 The prevalence is about 5% among
bone loss and bothersome galactorrhea.2,3 The men who present with impotence or infertility.1
primary aim of treatment in patients with pituitary
macroadenoma is to control the compressive
effects of the tumour, including compression of Prolactin molecule
optic chiasm, with a secondary goal to restore Prolactin is a 23 kDa polypeptide hormone (198
gonadal function. However, indications and amino acids) synthesized in the lactotroph cells of
modalities of treatment of hyperprolactinemia due the anterior pituitary gland. Its secretion is
to pituitary microadenomas are less well defined.2 pulsatile and increases with sleep, stress, food
Medications in the form of dopamine agonists are ingestion, pregnancy, chest wall stimulation, and
the first line of treatment, with surgery and trauma. Macroprolactinemia denotes the situation
radiotherapy reserved for refractory and in which there is high level of the circulating ‘big
medication-intolerant patients.2 Treatment with prolactin’ molecules of 50 and 150 kDa (PRL-IgG
dopamine agonists can restore normal prolactin complexes); which have high immunogenic
levels and gonadal function. However, the choice properties, but poor or no biological effect. When
of which dopamine agonist is most efficacious and these big variants circulate in large amounts, the
produces the least adverse effects is unclear. To condition is referred to as “macroprolactinemia”,
provide evidence-based recommendations to identified as hyperprolactinemia by the commonly
practicing clinicians facing these common used immune assays. Many commercial assays do
therapeutic dilemmas, in this review we not detect macroprolactin. Macroprolactin in the
summarize advances in our understanding of the serum can be detected by Polyethylene glycol
clinical significance of hyperprolactinemia and its precipitation.4 In these situations even though high
pathogenetic mechanisms, including the influence levels of circulating prolactin hormone are
of concomitant medication use, effects with detected, the biological prolactin is normal and so
medications, surgery and radiotherapy in there are no clinical symptoms, although a smaller
hyperprolactinemic patients. proportion of patients with macroprolactinemia
may have symptoms.5-8 It should be suspected
when typical symptoms of hyperprolactinemia are
Prevalence absent.9,10 As macroprolactinemia is common in
An excess of prolactin above a reference hyperprolactinemia, routine screening for
laboratory’s upper limits, or “biochemical macroprolactinemia could eliminate unnecessary
hyperprolactinemia,” can be identified in up to diagnostic testing as well as treatment in cases of
10% of the population.1 The prevalence of asymptomatic hyperprolactinemic subjects.6
hyperprolactinemia ranges from 0.4% in an
unselected adult population to as high as 9-17% in
Regulation of prolactin secretion
women with reproductive diseases. Its prevalence
was found to be 5% in a family planning clinic.4 The main biological action of prolactin is inducing
Women with oligomenorrhea, amenorrhea, and maintaining lactation. However, it also exerts
Delta Med Col J. Jul 2018;6(2) 91
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metabolic effects, takes part in reproductive Etiology of hyperprolactinemia16

mammary development and stimulates immune 1. Physiologic hypersecretion
responsiveness.11,12 Plenty of mediators of central, Pregenency
pituitary, and peripheral origin take part in Lactation
regulating prolactin secretion through a direct or Chest wall stimulation
indirect effect on lactotroph cells.5 Like most Sleep
anterior pituitary hormones, prolactin is under Stress
dual regulation by hypothalamic hormones
2. Idiopathic hyperprolectinaemia (40%)
delivered through the hypothalamic–pituitary
3. Hypothalamic-pituitary stalk damage
portal circulation. The predominant signal is tonic
Tumours: Craniopharyngioma, meningioma,
inhibitory control of hypothalamic dopamine dysgerminoma, dermoid cyst, pineal gland tumours
which traverses the portal venous system to act Empty sella
upon pituitary lactotroph D2 receptors. Other Lymhocytic hypophysitis
prolactin inhibiting factors include gamma amino
Rathke’s cyst
butyric acid (GABA), somatostatin, acetylcholine,
Irradiation
and norepinephrine. The second signal is
Trauma
stimulatory which is provided by the
Pituitary stalk lesion
hypothalamic peptides, thyrotropin releasing
hormone (TRH), vasoactive intestinal peptide Suprasellar surgery
(VIP), epidermal growth factor (EGF), and 4. Pituitary hypersecretion
dopamine receptor antagonists.13,14 Actual serum Prolactinoma
prolactin level is the result of a complex balance Metastatic tumors
between positive and negative stimuli derived Tuberculosis
from both external and endogenous environments. Sarcoidosis
Serotonin physiologically mediates nocturnal Histiocytosis
surges and suckling-induced prolactin rises and is Acromegaly
a potent modulator of prolactin secretion. Cushing disease
Histamine inhibits the dopaminergic system and Addison’s disease
has a predominantly stimulatory effect. Estrogen 5. Systemic disorders
stimulates pituitary lactotroph proliferation Chronic renal failure
especially during pregnancy. However, during
Hypothyroidism
pregnancy lactation is inhibited by high levels of
Ectopic production
estrogen and progesterone. In the postpartum
Cirrhosis
period, estrogen and progesterone rapidly decline
Pseudocyesis
which allows lactation to commence. During
lactation and breastfeeding, ovulation may be Epileptic seizures
suppressed due to the suppression of 6. Drug induced
gonadotropins by prolactin, but may resume Dopamin receptor blocker
before menstruation resumes.15 Dopamin depleting agents
Histamin receptor antagonists
Stimulator of serotonergic pathway
Causes of hyperprolactinemia Estrogens, antiandrogens
Hyperprolactinemia can be physiological or Serotonin reuptake inhibitors
pathological. Calcium channel blockers

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Physiological hyperprolactinemia is usually mild prolactin excess. Clinical presentation in women

or moderate. During normal pregnancy, serum is more obvious and occurs earlier than in men.
prolactin rises progressively to around 200-500 Women can present with symptoms of
ng/mL. Many common medications cause mild oligomenorrhea, amenorrhea, galactorrhea,
hyperprolactinemia where prolactin levels rise up decreased libido, infertility, and decreased
to less than 100 ng/mL. Pathological bone mass.
hyperprolactinemia can be caused by both Table I: Clinical presentations of hyperprolactinemia
hypothalamic-pituitary disease (prolactinomas) as
Premenopausal women
well as non-hypothalamic-pituitary disease. The • Marked prolactin excess (>100 μg/L [normally <25 μg/L]) is commonly associated with
presence of a secondary cause and fluctuating hypogonadism,* galactorrhea and amenorrhea
degrees of hyperprolactinemia should raise the • Moderate prolactin excess (51–75 μg/L) is associated with oligomenorrhea
suspicion of a non tumourous cause. • Mild prolactin excess (31–50 μg/L) is associated with short luteal phase, decreased libido and

Prolactinomas account for 25-30% of functioning infertility

• Increased body weight may be associated with prolactin-secreting pituitary tumour19
pituitary tumours and are the most frequent cause
• Osteopenia is present mainly in people with associated hypogonadism
of chronic hyperprolactinemia.17 Prolactinomas • Degree of bone loss is related to duration and severity of hypogonadism*20
are divided into two groups: (1) microadenomas Men
(smaller than 10 mm) which are more common in • Hyperprolactinemia presents with decreased libido, impotence, decreased sperm production,
premenopausal women, and (2) macroadenomas infertility, gynecomastia and, rarely, galactorrhea
(10 mm or larger) which are more common in men • Impotence is unresponsive to testosterone treatment and is associated with decreased muscle
mass, body hair and osteoporosis21
and postmenopausal women. Pituitary adenomas
*The degree of hypogonadism is generally proportionate to the degree of prolactin elevation.
co-secreting prolactin hormone also raise
prolactin levels. Hypothalamus and pituitary stalk Diagnostic evaluation
lesions such as nonfunctioning adenomas,
Normal serum prolactin levels vary between 5 and
gliomas, and craniopharyngiomas also result in
25 ng/mL in females although physiological and
prolactin elevation.18 The hyperprolactinemia of
hypothyroidism is related to several mechanisms. diurnal variations occur.22 Serum prolactin levels
In response to the hypothyroid state, there is a are higher in the afternoon than in the morning,
compensatory increase in the discharge of central and hence should preferably be measured in the
hypothalamic thyrotropin releasing hormone morning. Hyperprolactinemia is usually defined as
which results in increased stimulation of prolactin fasting levels of above 20 ng/mL in men and above
secretion. Furthermore, prolactin elimination from 25 ng/mL in women12 at least 2 hours after
the systemic circulation is reduced. There may be waking up. For evaluation of hyperprolactinemia,
diffuse pituitary enlargement in primary physiologic causes, including pregnancy in
hypothyroidism, which is reverseible with women of childbearing age should be considered.
appropriate thyroid hormone replacement Interpretation of postpartum hyperprolactinemia
therapy.13 depends on interval after delivery and status of
lactation. Prolactin levels normalize within
approximately 6 months after delivery in nursing
Clinical presentations mothers and within weeks in non-nursing
The clinical manifestations of prolactin excess mothers.23 Elevations in prolactin levels due to
(Table I) can be categorized into two groups, those stalk compression rarely exceed 150 μg per liter,
that are due to prolactin excess and those but the use of antipsychotic agents or
representing the consequences of the resulting metoclopramide can increase prolactin levels to
hypogonadism. The clinical manifestations of more than 200 μg per liter. Clinical manifestations
conditions vary significantly depending on the age of drug-induced hyperprolactinemia are similar to
and the sex of the patient and the magnitude of the those of prolactinomas, except for tumour mass

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effects.24,25 Most patients with prolactin levels

more than 150 μg per liter have associated
symptoms though the Ssymptoms do not correlate
well with prolactin levels. Macroprolactin, can
cause spurious hyperprolactinemia because of
delayed clearance.6 Unless the prolactin levels are
markedly elevated, the investigation should be
repeated before labeling the patient as
hyperprolactinemic. Even one normal value
should be considered as normal and an isolated
raised one should be discarded as spurious. Other
common conditions which must be excluded when
considering raised prolactin levels are non-fasting
sample, excessive exercise, history of drug intake,
chest wall surgery or trauma, renal disease,
cirrhosis, and seizure within 1-2 hours. These
conditions usually cause prolactin elevation of
Fig 1: Overview of diagnosis and management
<50 ng/mL. Plain radiographs have been replaced
of hyperprolactinemia
by cross-sectional imaging techniques such as CT
scanning and MRI. Currently, MRI remains the
method of choice for evaluation of pituitary Management
tumors. Lesions that are iso-dense with
The objective of hyperprolactinemia treatment is
surrounding structures may not be identified well
to correct the biochemical consequences of the
with CT scan.26 In patients with microadenomas
hormonal excess.
pituitary function is typically normal. In
amenorrheic women, serum levels of Objectives of treatment of hyperprolactinemia29
follicle-stimulating hormone should be measured Restoration and maintenance of normal
to rule out primary ovarian failure, and serum gonadal function.
testosterone levels should be assessed in men with
Restoration of normal fertility.
hyperprolactinemia; infertility (in patients
desiring fertility) is an indication for therapy. Bone Prevention of osteoporosis.
density should be evaluated in patients with If a pituitary tumour is present:
hypogonadism. Patients with macroadenomas
adjacent to the optic chiasm or compressing it Correction of visual or neurological
require visual-field testing as visual compromise abnormalities.
needs rapid treatment.27 The hyperprolactinemia Reduction or removal of tumour mass.
is referred to as “idiopathic” in cases where other
Preservation of normal pituitary function.
causes of hyperprolactinemia have been excluded
and no adenoma can be visualized with MRI Prevention of progression of pituitary or
(Figure 1).28 hypothalamic disease.

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For management purpose, hyperprolatinemics can Table II: Advantages, disadvantages and cost of
be broadly divided into three groups. various dopamine agonist agents available
Agent Main advantages Disadvantages Typical dose
Management of hyperprolactnemia based on Bromocriptine Longest track record High frequency of 2.5 mg/day

etiology30 gastrointestinal upset and

sedation

Group 1 Cabergoline High efficacy; less adverse Experience during 0.5 mg/week
events; indicated in cases pregnancy relatively

Dopamine agonist is the mainstay of management of bromocriptine resistance limited

or intolerance
in patients desiring fertility, with symptoms of Quinagolide Pituitary selectivity; Daily use; limited access 0.075 mg/day

estrogen deprivation or with galactorrhea. indicated in cases of

bromocriptine resistance or

Idiopathic hyperprolactinemia intolerance

Pergolide Occasionally beneficial in High frequency of adverse 0.25 mg/day
resistant cases events
Bromocriptine is the first option for this condition
and is the drug used for the longest period of time.
Dopamine agonists have been in clinical use for
It is best to give as continuous therapy and
many years and remain the cornerstone for therapy
prolactin levels reduce in about a week; ovulation
of prolactinomas.30,31 All (except quinagolide) are
and menstruation resumes in 4-8 weeks. Most
ergot alkaloids. Current recommendations
popular method to confirm resumption of
advocate dopamine agonist therapy according to
ovulatory function in oligo or amennorrhic women patient's requirement. Most commonly used
is weekly assessment of progesterone. Ovulation dopamine agonists are bromocriptine and
rates achieved by medical therapy with dopamine cabergoline. Others are lisuride, pergolide,
agonist alone are approximately 80-90% if there is quinagolide, terguride, and metergoline. Patients
no other cause for anovulation other than who are intolerant or fail to respond to one agent
hyperprolactinemia.30,31 In the remaining women, may do well with another.
exogenous gonadotropin stimulation can be added
Side effects associated with these drugs are
along with dopamine agonist to achieve ovulation.
nausea, vomiting, headache, constipation,
Microadenoma with hyperprolactinemia dizziness, faintness, depression, postural
Medical management can be continued for 18 hypotension, digital vasospasm, and nasal
stuffiness. These symptoms are most likely to
months to 6 or more years. Tumour expansion may
occur with initiation of treatment or when the dose
occur during pregnancy in less than 2% of cases.
is increased. One rare but notable side effect is
No treatment is required in asymptomatic and very
neuropsychiatric symptoms which present as
slow growing tumours which do not metastasize.
auditory hallucinations, delusion, and mood
Follow-up is mandatory with yearly estimation of
changes. It quickly resolves with discontinuation
prolactin levels, MRI, and visual fields. However,
of the drug.32 Previous concerns about valvular
hormone replacement therapy (HRT) to replenish
heart disease with the use of these agents have
estrogen deficit should be given to all patients with
largely been disproved by more recent reports.33-36
amenorrhea.
Bromocriptine is a lysergic acid derivative with a
Medical therapeutic options for the management bromine substitute at position 2.37 It is a strong
of hyperprolactinemia dopamine agonist which binds to dopamine
Medical therapy has traditionally involved receptor and directly inhibits PRL secretion. It
agonists of the physiologic inhibitor of prolactin, decreases prolactin synthesis, DNA synthesis, cell
dopamine (Table II).28 multiplication, and overall size of prolactinoma. It

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has a short half-life and so it requires twice daily Group 2

administration to maintain optimal suppression of Macroadenoma with hyperprolactinemia
prolactin levels. Intolerance to bromocriptine is
common and it is the main indication of using an The aim of the treatment is reduction in tumour
alternative drug. Tolerance is better when started mass along with the correction of the biochemical
with the lowest possible dose of 1.25 mg/day after consequences of the hormonal excess including
dinner and then increased gradually by 1.25 mg restoration of fertility, prevention of bone loss, and
each week until prolactin levels are normal or a suppression of galactorrhea.3
dose of 2.5 mg twice daily is reached which is Dopamine agonists are the first line of treatment
effective in 66% cases.38 However, one can start with surgery and radiotherapy reserved for
with 7.5 mg/day dosage to save time and 90% will refractory and medication intolerant patients.44
respond. Macroprolactinomas regress with medication but
Another alternative is vaginal usage of the same the response is variable. Some show prompt
drug which is well tolerated. Vaginal absorption is shrinkage with low doses while others may require
nearly complete and lower therapeutic dosing is prolonged treatment with higher dosage.
possible as it avoids the liver first pass Reduction in tumour size can take place in several
metabolism.39 It is also available in a long acting days to weeks.17,45
form (depot-bromocriptine) for intramuscular
Surgical removal of tumours associated with
injection and a slow release oral form.40,41
prolactin excess requires careful consideration of
Bromocriptine has good treatment results but after
treatment objectives. It is indicated in patients
discontinuation of treatment prolactin returns to
with nonfunctional pituitary adenomas or other
elevated levels in 75% of patients and there is no
non-lactotroph adenomas associated with
clinical or laboratory assessment to predict
hyperprolactinemia and in patients in whom
long-term beneficial result.42
medical therapy has been unsuccessful or poorly
Cabergoline shares many characteristics and tolerated.
adverse effects of bromocriptine but has a very
Indications for pituitary surgery in patients
long half-life allowing weekly dosing. This is
with hyperprolactinemia27
more effective in suppressing prolactin and
reducing tumour size.30 The low rate of side Increasing tumour size despite optimal
effects and the weekly dosage make cabergoline a medical therapy.
better choice for initial treatment. It can also be Pituitary apoplexy.
given vaginally if nausea occurs when taken
orally.43 A dose of 0.25 mg twice per week is Inability to tolerate dopamine agonist therapy.
usually adequate for hyperprolactinemia. Dopamine agonist–resistant macroadenoma.
Maximum dose that can be given is 1 mg twice a
Dopamine agonist–resistant microadenoma in
week.
a woman seeking fertility.
Though both drugs have been found to be safe in
If ovulation induction is not appropriate.
pregnancy, the number of reports studying
bromocriptine in pregnancy far exceeds that of Persistent chiasmal compression despite
cabergoline.38 optimal medical therapy.

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In women seeking fertility, macroadenoma in External radiation therapy is only reserved for
close proximity to optic chiasm despite residual tumour in patients who have undergone
optimal medical therapy (pre pregnancy surgery and there is incomplete resection. It is of
debulking recommended). very limited benefit since the response is typically
quite modest and delayed.47 There is also a risk of
Cerebrospinal fluid leak during administration developing hypopituitarism. Bromocriptine has
of dopamine agonist. been used in patients where surgery or combined
Macroadenoma in a patient with a psychiatric surgery and radiation therapy is failed.
condition for which dopamine agonists are
contraindicated.
Group 3
Transnasal transsphenoidal microsurgical excision
Around 40% patients with primary
of prolactinoma is a widely chosen as it is a safe
hypothyroidism have mild elevation of PRL levels
procedure. It is usually recommended for very
that can be normalized by thyroid hormone
large tumours, those with suprasellar and frontal
replacement.16 Medications that can cause
extension, and visual impairment persisting after
hyperprolactinemia should be discontinued for
medications. Besides the usual surgical risks,
48-72 hours if it is safe to do so and serum
hypopituitarism is a potential long-term effect of
prolactin level repeated. Sometimes the causative
surgery and patients should be counseled properly
agent is essential for the patient's health (for e.g., a
beforehand. Unfortunately, relapse is common as psychotropic agent) but it may cause symptomatic
excision is often incomplete but prolactin levels hypogonadism. In these patients, treatment with a
are lower than before. Prolactin levels should be dopamine agonist should be avoided since it might
monitored regularly. First after 4 weeks of starting compromise the effectiveness of the psychotropic
therapy and then repeated after 3-6 months drug and the patient should simply be treated with
depending on symptom reversal. Repeat MRI is replacement of sex steroids.
done after 6 months of normalization of prolactin
About 30% patients with chronic renal failure and
levels. Further evaluation is done with 6 monthly
up to 80% patients on hemodialysis have raised
prolactin levels. Scanning should be repeated only
prolactin levels. This is probably due to either
if symptoms reappear or exacerbate.
decreased clearance or increased production of
There are several possible explanations for the prolactin as a result of disordered hypothalamic
recurrence or persistence of hyperprolactinemia regulation of prolactin secretion. Correction of the
after surgery as listed below: renal failure by transplantation results in normal
a. Tumour may be multifocal in origin PRL levels.

b. Complete resection is difficult because

prolactin producing tumour looks like the Management of hyperprolactinemia in
surrounding normal pituitary pregnancy
c. There may be continuing abnormality of the The collaboration of various specialists, including
hypothalamus giving rise to chronic an obstetrician, is required for the careful planning
stimulation of the lactotrophs and recurrent of pregnancy in women with hyperprolactinemia.
hyperplasia. However, pituitary tumours are Ideally, this should occur before conception, to
monoclonal in origin as indicated by permit a full assessment of the risks and benefits
molecular biology studies.46 of dopamine agonist therapy during pregnancy.

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Management of hyperprolactinemia in of medical therapy is the potential need for

pregnancy48,49 lifelong treatment. The Pituitary Society has
There is no evidence of increased teratogenicity published guidelines for the diagnosis and
associated with bromocriptine or cabergoline use management of prolactinomas.2 These guidelines
during pregnancy suggest that discontinuation of dopamine agonist
therapy can be attempted in selected patients who
Similarly, there is no evidence of increased
have had normal prolactin levels for at least 2
risk of abortion or multiple pregnancies with
years and minimal residual tumour volume.
dopamine agonist use
However, such patients need to be followed
If the tumour size before pregnancy is<10 mm, carefully, since tumour recurrence is common,
dopamine agonist therapy is stopped during
particularly in the case of macroadenomas. Unless
pregnancy because the risk of tumour
there is evidence of growth of a prolactinoma or
expansion is low
related symptoms, such as headache, there is no
If the tumour size before pregnancy is≥10 mm indication to continue dopamine agonist therapy
before pregnancy, bromocriptine use is after menopause.42 After discontinuation of
advised during pregnancy to avoid significant treatment, regular monitoring of clinical
tumour expansion symptoms and prolactin levels is recommended.
All patients should be evaluated every 2 Given the propensity for early recurrence,
months during pregnancy prolactin levels should be measured monthly for
Formal visual field testing is indicated in the first 3 months and every 6 months thereafter.
patients with symptoms or a history of
macroadenoma
Conclusion
If visual field defects develop despite
dopamine agonist treatment, early delivery or It is important to establish the pathological
pituitary surgery should be considered relevance of hyperprolactinemia before
commencing treatment for this endocrinological
In most women with prolactinomas,
disorder. Pituitary function should be tested in
hyperprolactinemia persists after delivery;
patients with macroadenomas, and visual-field
although spontaneous resumption of menses and
testing is mandatory when tumours are adjacent to
remission of hyperprolactinemia can occur.50
the optic chiasm. Although microadenomas may
Prolactin levels and tumour size typically remain
stable during nursing. In patients with a or may not require therapy, macro-adenomas do
macroadenoma requiring treatment after delivery, require therapy. Most cases of true
dopamine agonists are administered, and hyperprolactinemia are associated with
therefore, nursing is not possible. amenorrhea or hormone deprivation in
premenopausal women and can be managed by
dopamine agonist or hormone replacement
Monitoring and Follow-up therapy respectively. If a normal prolactin level is
Biochemical and clinical improvements in maintained and if there is minimal residual tumour
response to dopamine agonist therapy are readily during medical therapy, available data suggest that
apparent in most patients. In addition, tumour it may be reasonable to discontinue therapy after 2
shrinkage can be expected in about 80% of years, although recurrence rates are high and close
macroadenomas.50 However, a major drawback follow-up is necessary.

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