Hyperprolactinemia Treatment & Management
- Author: Donald Shenenberger, MD, FAAD, FAAFP; Chief Editor: George T Griffing, MD more...
Direct treatment is geared toward resolving hyperprolactinemic symptoms or reducing tumor size. Patients on medications that cause hyperprolactinemia should have them withdrawn if possible. Patients with hypothyroidism should be given thyroid hormone replacement therapy.
When symptoms are present, medical therapy is the treatment of choice. Patients with hyperprolactinemia and no symptoms (idiopathic or microprolactinoma) can be monitored without treatment. Consider treatment for women with amenorrhea. In addition, duel energy radiographic absorptiometry scanning should be considered to evaluate bone density.
In cases of pharmacologic-induced hyperprolactinemia, an evaluation of the risk-benefit profile of the causative agent is imperative. Stopping the drug is ideal, but this may not be feasible. A good example would be in the schizophrenic patient in whom a single antipsychotic agent is the cause, but is keeping the patient’s psychoses under control. The cautious addition of a dopamine agonist may be considered.
The persistent hypogonadism associated with hyperprolactinemia can lead to osteoporosis. Baseline dual-energy x-ray absortiometry (DEXA) scanning is appropriate. Treatment significantly improves the patient's quality of life. If the goal is to treat hypogonadism only, patients with idiopathic hyperprolactinemia or microadenoma can be treated with estrogen replacement and prolactin levels can be monitored.
Radiation treatment is another option. However, the risk of hypopituitarism makes this a poor choice. It may be necessary for rapidly growing tumors, but its benefits in routine treatment have not been shown to outweigh the risks.
General indications for pituitary surgery include patient drug intolerance, tumors resistant to medical therapy, patients who have persistent visual-field defects in spite of medical treatment, and patients with large cystic or hemorrhagic tumors.
In patients with symptomatic prolactinomas who are either not responding to high doses of dopamine agonists or cannot tolerate the high doses necessary, transspenoidal surgery has been suggested as the best treatment. However, no controlled studies have evaluated the surgical outcomes in medically resistant tumors.
Physicians who are comfortable with the initial evaluation of a patient (without evidence of tumor mass effect) can easily initiate therapy and provide follow-up. However, given the time constraints of modern ambulatory medicine, consultation with an endocrinologist is often necessary.
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