Hyperprolactinaemia: Diagnosis and Management

Abstract

The patient with hyperprolactinaemia most commonly presents with infertility, menstrual irregularities, and/or gallactorrhoea. A complete history, physical examination, and measurement of prolactin and thyroid stimulating hormone (TSH) levels are the initial investigations. Hyperprolactinaemia can be physiologie, idiopathic, drug induced or secondary to numerous underlying disorders. When a cause cannot be found, radiological investigation with computed tomography (CT scan) or magnetic resonance imaging (MRI) of the hypothalamic pituitary area should be carried out. The choice of therapy depends on the pathological cause and the goals of the patient. When hypothyroidism is the cause, thyroid replacement therapy will correct the prolactin level. Treatment of pituitary micro-adenomas and idiopathic hyperprolactinaemia is aimed at the symptoms, Pituitary macro-adenomas should be treated for life with a dopamine agonist such as bramocriptine or pergolide. Two new drugs, quinagolide (CV205-502) a non-ergot dopamine agonist, and cabergoline, a long-acting dopamine agonist are currently undergoing clinical trials. They offer promising alternatives for the future treatment of hyperprolactinaemia. Surgery should be the second line of treatment if dopamine agonist therapy fails or is poorly tolerated. Macro-adenomas tend to regrow alter surgery and radio therapy may be warranted. Pregnancy can be achieved with dopamine agonist therapy. If this is not tolerated, administration of gonadotrophin releasing harmone (GnRH) by pump is effective. Therapy can be discontinued during pregnancy, although teratogenic effects have not been reported. Macro-adenomas should be kept under surveillance during pregnancy with routine history and physical examinations, and with bimonthly visual field examinations.