eMedicine Specialties > Endocrinology > Pituitary Gland

Hyperprolactinemia: Follow-up

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

Updated: Mar 12, 2010

Follow-up

Further Outpatient Care

Once the diagnosis has been established and therapy initiated, fasting prolactin levels should be monitored monthly. Later, prolactin levels can be monitored every 3-6 months. Shrinkage of the tumor should be followed by formal visual-field testing and MRI.

Complications

Potential complications of hyperprolactinemia are primarily related to tumor size and the physiologic effects of the condition. These include blindness, hemorrhage, osteoporosis, and infertility.

Prognosis

  • When monitored for longer than 7 years, 90-95% of microadenomas remained stable or gradually decreased prolactin secretion.
  • One third of patients with idiopathic hyperprolactinemia may experience resolution without treatment. This number increases to two thirds if the patient's basal prolactin level is less than 40 ng/mL.
  • Surgery is often not curative for macroprolactinomas, with a recurrence rate of as high as 40% within 5 years.
  • Recurrence rates of hyperprolactinemia are as high as 80%, and, subsequently, patients require long-term medical therapy.

Patient Education

  • A decrease in prolactin levels may restore ovulation. Advice about birth control methods should be given when prolactin levels approach the normal range.
  • For excellent patient education resources, visit eMedicine's Women's Health Center. Also, see eMedicine's patient education article Amenorrhea.

Miscellaneous

Medicolegal Pitfalls

The primary reason physicians are sued is failure to diagnose, regardless of the diagnosis. The diagnosis of hyperprolactinemia is often made during the evaluation of the patient's complaints. This condition is easily diagnosed unless the physician fails to consider it in his or her differential.

 
Acknowledgments

The editors would like to thank Treyce Knee, MD, for previous contributions to this article.



More on Hyperprolactinemia

Overview: Hyperprolactinemia
Differential Diagnoses & Workup: Hyperprolactinemia
Treatment & Medication: Hyperprolactinemia
Follow-up: Hyperprolactinemia
References
Further Reading
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References

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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

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Contributor Information and Disclosures

Author

Donald Shenenberger, MD, FAAD, FAAFP, Staff Dermatologist, Department of Dermatology, Naval Medical Center Portsmouth
Donald Shenenberger, MD, FAAD, 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.

 
 
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