Guidelines for the diagnosis and treatment of hyperprolactinemia

Hyperprolactinemia is the most common endocrine disorder of the hypothalami c-pituitary axis. While if can occur in men, it occurs more commonly in wom en. The prevalence of hyperprolactinemia ranges from 0.4% in an unselected normal adult population to as high as 9-17% in women with reproductive diso rders. There are many possible muses of hyperprolactinemia, falling into th ree general categories: physiologic, pharmacologic and pathologic. When spe cific treatable underlying causes have been eliminated and in cases Of seve re hyperprolactinemia, the most likely cause is a prolactin (PRL)-secreting pituitary adenoma. Microadenomas should be treated medically, with a dopam ine agonist, if there is an indication for therapy (such as amenorrhea, inf ertility or bothersome galactorrhea). If there is no indication for therapy , microadenomas may be followed conservatively, as growth is uncommon. Macr oadenomas may grow larger; medical therapy is recommended initially, with n eurosurgical evaluation reserved for specific clinical situations, such as failure of medical therapy and evidence of mass effect despite medical ther apy. In the United States, the dopamine agonists indicated for treatment of hyperprolactinemia are bromocriptine and cabergoline. Bromocriptine is usu ally given once or twice daily, while cabergoline has a long duration of ac tion and is given once or twice weekly. Results of comparative studies indi cate that cabergoline is clearly superior to bromocriptine in efficacy (PRL suppression, restoration of gonadal function) and tolerability.