Abstract: Hyperprolactinaemia can be physiological, pathological or drug-induced. An elevated serum concentration of prolactin can cause secondary hypogonadism via inhibition of hypothalamic gonadotrophin-releasing hormone and pituitary gonadotrophins. Therefore, determining pathological causes of hyperprolactinaemia, particularly those due to a prolactinoma, is important. Female patients may present with galactorrhoea, menstrual irregularity and infertility, whereas men may present with symptoms of secondary hypogonadism. Macroprolactin is a polymeric form of prolactin, representing less than 5% of circulating prolactin, which has limited bioavailability and bioactivity. In patients with a raised prolactin concentration who lack the typical features of hyperprolactinaemia, macroprolactinaemia should be suspected and sought. Following confirmation of an elevated serum prolactin and exclusion of other physiological and pathological causes, pituitary magnetic resonance imaging should be performed to investigate the presence of a prolactinoma or non-prolactinoma pituitary tumour. Bromocriptine and cabergoline are the two dopamine agonists used most commonly to normalize serum prolactin concentration. Both agents cause tumour shrinkage in prolactinomas, and restore gonadal function and fertility, but cabergoline is preferred as it is more effective and better tolerated. Although there are more safety data for bromocriptine than cabergoline, both agents are considered to be safe in pregnancy.
Publication Year: 2002
Publication Date: 2002-02-01
Language: en
Type: article
Indexed In: ['crossref']
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