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Feature Article

Hyperprolactinaemia: diagnostic and management challenges

Jessie Teng, Nirupa Sachithanandan

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Abstract

Pregnancy and medications are the two most common causes of hyperprolactinaemia in the primary care setting. A detailed history and examination is required to exclude secondary causes of the condition. Medical therapy with dopamine agonists is highly effective and the mainstay of treatment in patients with symptomatic hyperprolactinaemia or macroprolactinomas.

Key Points

  • Hyperprolactinaemia should be suspected in premenopausal women with menstrual disturbance and/or galactorrhoea and in men with symptomatic hypogonadism.
  • Drug-induced hyperprolactinaemia is common, and antipsychotics are frequently implicated. A baseline prolactin measurement is recommended before commencement of long-term antipsychotic treatment.
  • Dopamine agonists are first-line therapy for symptomatic hyperprolactinaemia or macroprolactinomas.
  • Management of prolactinomas during pregnancy can be challenging and is best co-ordinated in the setting of a multidisciplinary team comprising an endocrinologist, neurosurgeon and obstetrician.

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