eMedicine Specialties > Endocrinology > Pituitary Gland

Hyperprolactinemia: Differential Diagnoses & Workup

Author: Donald Shenenberger, MD, FAAFP, Staff Dermatologist, Department of Dermatology, Naval Medical Center Portsmouth
Contributor Information and Disclosures

Updated: Aug 12, 2009

Differential Diagnoses

Acromegaly
Hypothyroidism
Acute Renal Failure
Pituitary Macroadenomas
Erectile Dysfunction
Pituitary Microadenomas
Herpes Zoster
Prolactinoma

Other Problems to Be Considered

Alcoholic cirrhosis
Pregnancy
Postparturition
Nipple stimulation
Nonfasting specimen
Drug effect
Postictal state
Chest wall trauma
Chest wall tumors

Workup

Laboratory Studies

  • Generally, hyperprolactinemia is discovered in the course of evaluating a patient's presenting complaint, for instance amenorrhea, galactorrhea, or erectile dysfunction. Occasionally, several fasting measurements of prolactin must be obtained.
  • Current thyroid-stimulating hormone assays are very sensitive for detecting hypothyroid conditions.
  • Measuring blood urea nitrogen and creatinine is important for detecting renal failure.
  • History of alcohol abuse and abdominal examination may give clues for cirrhosis as a possible etiology.
  • Pregnancy testing is required unless the patient is postmenopausal or has had a hysterectomy.
  • Patients with macroadenoma should be evaluated for possible hypopituitarism. Male patients should have testosterone levels checked.
  • Many patients with acromegaly have prolactin co-secreted with growth hormone. Anyone thought to have acromegaly should be evaluated with an insulin-like growth factor-1 (IGF-1) level measurement and a glucose tolerance test for nonsuppressible growth hormone levels if needed.

Imaging Studies

Although modern high-speed helical CT scanners produce very detailed images, MRI is the imaging study of choice. MRI can detect adenomas that are as small as 3-5 mm.

Other Tests

These would be determined by any identified cause, (eg, visual-field testing especially if a pituitary macroadenoma is found or if optic nerve involvement is noted on imaging studies).

More on Hyperprolactinemia

Overview: Hyperprolactinemia
Differential Diagnoses & Workup: Hyperprolactinemia
Treatment & Medication: Hyperprolactinemia
Follow-up: Hyperprolactinemia
References
Further Reading
[ CLOSE WINDOW ]

References

  1. Nilsson LA, Roepstorff C, Kiens B, et al. Prolactin suppresses malonyl-CoA concentration in human adipose tissue. Horm Metab Res. Jun 23 2009;[Medline].

  2. Schlechte JA. Long-term management of prolactinomas. J Clin Endocrinol Metab. August 2007;92(8):2861-5. [Medline].

  3. Sathyapalan T, Gonzalez S, Atkin SL. Effect of long-term, high-dose estrogen treatment on prolactin levels: a retrospective analysis. Climacteric. Jul 21 2009;1-4. [Medline].

  4. Nachtigall LB, Valassi E, Lo J, McCarty D, Passeri J, Biller BM, et al. Gender effects on cardiac valvular function in hyperprolactinaemic patients receiving cabergoline: a retrospective study. Clin Endocrinol (Oxf). Apr 17 2009;[Medline].

  5. Kharlip J, Salvatori R, Yenokyan G, Wand GS. Recurrence of hyperprolactinemia after withdrawal of long-term cabergoline therapy. J Clin Endocrinol Metab. Jul 2009;94(7):2428-36. [Medline].

  6. Biller MKB, Daniels GH. Neuroendocrine regulation and diseases of the anterior pituitary and hypothalamus. In: Braunwald E, Isselbacher KJ, Wilson J, et al. Harrison's Principles of Internal Medicine. 14th ed. New York, NY: McGraw-Hill; 1998:1974-8.

  7. Blackwell RE. Hyperprolactinemia. Evaluation and management. Endocrinol Metab Clin North Am. Mar 1992;21(1):105-24. [Medline].

  8. Conner P, Fried G. Hyperprolactinemia; etiology, diagnosis and treatment alternatives. Acta Obstet Gynecol Scand. Mar 1998;77(3):249-62. [Medline].

  9. Davies PH. Drug-related hyperprolactinaemia. Adverse Drug React Toxicol Rev. Jun 1997;16(2):83-94. [Medline].

  10. Hartog M, Hull MG. Hyperprolactinaemia. BMJ. Sep 17 1988;297(6650):701-2. [Medline].

  11. Jones TH. The management of hyperprolactinaemia. Br J Hosp Med. Apr 19-May 2 1995;53(8):374-8. [Medline].

  12. Kaye TB. Hyperprolactinemia. Causes, consequences, and treatment options. Postgrad Med. May 1996;99(5):265-8. [Medline].

  13. Lancet. Management of prolactinoma. Lancet. Sep 15 1990;336(8716):661. [Medline].

  14. Molitch ME. Medical treatment of prolactinomas. Endocrinol Metab Clin North Am. Mar 1999;28(1):143-69, vii. [Medline].

  15. Prescrire International. Cabergoline and hyperprolactinaemia: new preparation. Better than bromocriptine. Prescrire Int. 2000;Feb;9(45):195-7. [Medline].

  16. Serri O, Chik CL, Ur E, Ezzat S. Diagnosis and management of hyperprolactinemia. CMAJ. Sep 16 2003;169(6):575-81. [Medline].

  17. Valdemarsson S. Macroprolactinemia. Risk of misdiagnosis and mismanagement in hyperprolactinemia. Lakartidningen. 2004;101(6):458-65. [Medline].

  18. Wilson JD. Endocrine Disorders of the Breast. In: Braunwald E, Isselbacher KJ, Wilson J, et al,. Harrison's Principles of Internal Medicine. 1998. 14th ed. New York, NY: McGraw-Hill; 2116-7.

[ CLOSE WINDOW ]

Further Reading

Related eMedicine topics:
 Luteinizing Hormone Deficiency
Ovarian Insufficiency
Pituitary Adenoma
Pituitary Disease and Pregnancy
Pituitary Macroadenomas
Pituitary Microadenomas
Prolactinoma

Clinical guidelines:
ACR Appropriateness Criteria® neuroendocrine imaging.
American College of Radiology - Medical Specialty Society.  1999 (revised 2006).  11 pages.  [NGC Update Pending] NGC:005121

Diagnosis of breast disease.
Institute for Clinical Systems Improvement - Private Nonprofit Organization.  1994 Jan (revised 2008 Jan).  47 pages.  NGC:006317

Stereotactic radiosurgery for patients with pituitary adenomas.
IRSA - Professional Association.  2004 Apr.  12 pages.  NGC:003598

Clinical trials:
 Calcium and Vitamin D to Optimize Bone Mass in Boys With Risperidone-Induced Hyperprolactinemia

Substrate Metabolism and Insulin Sensitivity in Patients With Hyperprolactinemia Before and After Treatment

The Luveris In Vitro Fertilization Trial

[ CLOSE WINDOW ]

Keywords

hyperprolactinemia, prolactin, prolactinoma, pituitary tumor, tumor pituitary, cabergoline, prolactin levels, macroprolactinomas, pituitary tumors, breast development, elevated serum prolactin level, pituitary adenoma, prolactin-secreting tumors, anterior pituitary gland, lactation, secondary amenorrhea, galactorrhea, oligomenorrhea, dopamine agonists, hypothyroidism

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Donald Shenenberger, MD, FAAFP, Staff Dermatologist, Department of Dermatology, Naval Medical Center Portsmouth
Donald Shenenberger, MD, FAAFP is a member of the following medical societies: American Academy of Dermatology, American Academy of Family Physicians, Association of Military Dermatologists, and Uniformed Services Academy of Family Physicians
Disclosure: Nothing to disclose.

Medical Editor

David M Klachko, MBBCh, Professor Emeritus, Department of Internal Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Missouri
David M Klachko, MBBCh is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, American Diabetes Association, American Federation for Medical Research, Endocrine Society, Missouri State Medical Association, and Sigma Xi
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Yoram Shenker, MD, Chief of Endocrinology Section, Veterans Affairs Medical Center of Madison; Interim Chief, Associate Professor, Department of Internal Medicine, Section of Endocrinology, Diabetes and Metabolism, University of Wisconsin at Madison
Yoram Shenker, MD is a member of the following medical societies: American Heart Association, Central Society for Clinical Research, and Endocrine Society
Disclosure: Nothing to disclose.

CME Editor

Mark Cooper, MBBS, PhD, FRACP, Head, Diabetes & Metabolism Division, Baker Heart Research Institute, Professor of Medicine, Monash University
Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD, Professor of Medicine, St Louis University School of Medicine
George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Medical Practice Executives, American College of Physician Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical Research, Endocrine Society, International Society for Clinical Densitometry, and Southern Society for Clinical Investigation
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.