Elevated serum prolactin causing hypogonadism, galactorrhoea and infertility; prolactinoma is the commonest pathological cause.
Causes
- • Prolactinoma
- • Drugs (antipsychotics, metoclopramide, opioids)
- • Pituitary stalk compression
- • Hypothyroidism
- • Pregnancy, chronic kidney disease
Investigations
- • Repeat prolactin (cannulated if stress suspected), macroprolactin
- • TFT, renal function, pregnancy test
- • Pituitary MRI if unexplained or >2000 mU/L
- • Visual fields if macroadenoma
Management
- • Cabergoline first line
- • Surgery if dopamine-agonist resistant or apoplexy
- • Review offending drugs with psychiatry
Clinical pearls
- • Very large adenoma with only mildly raised prolactin suggests hook effect — request dilution
- • Prolactin >5000 mU/L strongly favours macroprolactinoma
Related in WardRound
Educational — verify locally.
