Hyperprolactinemia in women: diagnostic approach

Abstract

Keypoints• Hyperprolactinemia (HPRL) is a cause of menstrual irregularity, galactorrhea, hypogonadism and infertility.• Serum prolactin measurement should only be performed in the presence of compatible symptoms and/or in the presence of a pituitary tumor, even with an incidental diagnosis. Dosage is not recommended as a routine examination. • There are several causes of HPRL. In most cases, it is caused by pregnancy, hypothalamic-pituitary disconnection or PRL-secreting pituitary adenomas (prolactinomas), or it can also be secondary to the use of medications. • Recognizing clinical, laboratory and imaging findings is essential for the diagnosis of prolactinoma, and its differential diagnoses. Recommendations• Hyperprolactinemia is a condition with diverse etiologies, and its correct identification is essential for the proper treatment and monitoring. • Mild hyperprolactinemia should be confirmed with a new measurement after excluding venipuncture stress. • Macroprolactin testing is indicated in patients with asymptomatic hyperprolactinemia.• If drug-induced hyperprolactinemia is suspected, a new serum prolactin measurement is recommended three days after discontinuation of the drug, when withdrawal is possible. If there is a contraindication and doubt regarding the etiology, pituitary imaging should be performed. • Sellar imaging by magnetic resonance, ideally, or computed tomography if the former is unavailable, should only be done after excluding other causes of HPRL. When sellar imaging is suggestive of a pituitary tumor, evaluate if the size of the lesion and prolactin levels point to the presumptive diagnosis of prolactinomas. FEBRASGO POSITION STATEMENTHyperprolactinemia in women: diagnostic approach