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Management of hyperprolactinemia

Peter J Snyder, MD
Section Editor
David S Cooper, MD
Deputy Editor
Kathryn A Martin, MD


Lactotroph adenomas (prolactinomas) are more amenable to pharmacologic treatment than any other kind of pituitary adenoma because of the availability of dopamine agonists, which usually decrease both the secretion and size of these tumors. For the minority of lactotroph adenomas that do not respond to dopamine agonists, other treatments must be used. Hyperprolactinemia due to nonadenoma causes should also be treated if it causes hypogonadism.

This topic will review the major issues concerning the therapy of hyperprolactinemia due to lactotroph adenomas and other causes, with the exception of treatment during pregnancy, which is discussed separately. The causes, clinical manifestations, and diagnosis of hyperprolactinemia are also discussed elsewhere. (See "Management of lactotroph adenoma (prolactinoma) during pregnancy" and "Causes of hyperprolactinemia" and "Clinical manifestations and evaluation of hyperprolactinemia".)


There are two principal reasons why patients with hyperprolactinemia may need to be treated: existing or impending neurologic symptoms due to the large size of a lactotroph adenoma, and hypogonadism or other symptoms due to hyperprolactinemia, such as galactorrhea [1,2].

A third indication is in women with mild hyperprolactinemia and normal cycles who are trying to conceive as they may have subtle luteal phase dysfunction (see "Clinical manifestations and evaluation of hyperprolactinemia", section on 'Menstrual cycle dysfunction'). Our approach to management is similar to that suggested by the Endocrine Society Guidelines [2].

Adenoma size — A lactotroph adenoma (prolactinoma) 1 cm or more in size is a macroadenoma. Treatment is usually essential when the tumor is large enough to cause neurologic symptoms, such as visual impairment or headache (see "Causes, presentation, and evaluation of sellar masses", section on 'Clinical manifestations'). Treatment is usually desirable when the adenoma extends outside of the sella and abuts or elevates the optic chiasm, or invades the cavernous or sphenoid sinuses or the clivus; lesions of this size are likely to continue to grow and eventually cause neurologic symptoms.

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Literature review current through: Oct 2017. | This topic last updated: Oct 24, 2016.
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