DIAGNOSIS AND TREATMENT OF HYPERPROLACTINAEMIA. AN OVERVIEW OF THE LATEST RECOMMENDATIONS

Abstract

Hyperprolactinaemia is the most common disorder of the hypothalamic-pituitary axis, causing sexual dysfunction, infertility and symptoms of hypogonadism. The most common pathological cause of hyperprolactinaemia is prolactinoma, for which treatment with cabergoline is considered to be the most effective treatment, while transsphenoidal surgery or radiation therapy is more often prescribed in the case of ineffective cabergoline treatment. Treatment of asymptomatic microprolactinomas is not recommended. Symptomatic hyperprolactinaemia caused by antipsychotic drugs is most effectively treated by adjusting antipsychotic treatment, prescribing low-dose dopamine agonists or sex hormone replacement therapy. Infertility caused by hyperprolactinaemia can be treated with dopamine agonists, but discontinuation of treatment is recommended after confirmation of pregnancy. Patients with prolactinoma-induced hyperprolactinaemia should be monitored during pregnancy as pregnancy may promote the growth of prolactin-secreting pituitary adenomas. Hyperprolactinaemia during pregnancy is usually treated with dopamine agonists, but only after the progression of symptoms. Hyperprolactinaemia after menopause is rare and it is recommended to discontinue treatment with dopamine agonists after the onset of menopause, unless a macroprolactinoma is detected and tumour size control is required.