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Hyperprolactinemia

Key sources
The following summarized guidelines for the evaluation and management of hyperprolactinemia are prepared by our editorial team based on guidelines from the European Society of Endocrinology (ESE 2021), the European Thyroid Association (ETA 2018), and the Endocrine Society (ES 2011).
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Guidelines

1.Screening and diagnosis

Diagnosis: obtain a single measurement of serum prolactin for the diagnosis of hyperprolactinemia and confirm the diagnosis with a level above the ULN as long as the serum sample is obtained without excessive venipuncture stress.
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  • Differential diagnosis

2.Diagnostic investigations

Serum prolactin levels: obtain a single measurement of serum prolactin for the diagnosis of hyperprolactinemia.
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  • Screening for central hypothyroidism

3.Medical management

Dopamine agonists: initiate dopamine agonist therapy to lower prolactin levels, decrease tumor size, and restore gonadal function in patients with symptomatic prolactin-secreting microadenomas or macroadenomas.
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  • Oral contraceptives

4.Therapeutic procedures

Radiotherapy: consider offering radiation therapy in patients failed surgical treatment or with aggressive or malignant prolactinomas.
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5.Surgical interventions

Transsphenoidal surgery: consider performing transsphenoidal surgery in symptomatic patients with prolactinomas not tolerating high doses of cabergoline or not responsive to dopamine agonist therapy.
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6.Specific circumstances

Patients contemplating pregnancy: as per ESE 2021 guidelines, manage female patients of reproductive age contemplating pregnancy with a diagnosis of pituitary adenoma, functioning or nonfunctioning, by an endocrinologist.
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  • Pregnant patients (monitoring)

  • Pregnant patients (management)

  • Pregnant patients (delivery and breastfeeding)

  • Patients with drug-induced hyperprolactinemia

  • Patients with malignant prolactinoma