ABSTRACT
Hyperprolactinemia is the most common endocrine disorder of the hypothalamic-pituitary
axis. A prolactinoma is the most common cause of chronic hyperprolactinemia once pregnancy,
primary hypothyroidism, and drugs that elevate serum prolactin levels have been excluded.
Patients can present with hypogonadism, infertility, galactorrhea, osteopenia, and
mass effects of the tumor. When hyperprolactinemia is confirmed, a cause for the disorder
needs to be sought. This involves a careful history and examination, followed by laboratory
tests and diagnostic imaging of the sella turcica. The goals of treatment are to normalize
prolactin levels, restore gonadal function, and reduce the effects of chronic hyperprolactinemia.
Dopamine agonists are the treatment of choice for the majority of patients. Transsphenoidal
surgery is usually reserved for patients who are intolerant of or resistant to dopamine
agonists or when hyperprolactinemia is caused by non-prolactin-secreting tumors compressing
the pituitary stalk. Cabergoline has been shown to be more effective and better tolerated
than bromocriptine. However, there are more data on the safety of the latter drug
during pregnancy and bromocriptine, therefore, remains the treatment of choice in
hyperprolactinemic women wishing to conceive.
KEYWORD
Hyperprolactinemia - prolactinoma - dopamine agonists - bromocriptine - cabergoline
- pregnancy
