Journal Mobile

AJ Sommerfield, AW Patrick
Journal Issue: 
Volume 35: Issue 2: 2005




Hyperprolactinaemia  is  the  most  common  hormonal  abnormality  affecting  the pituitary  gland.  The  most  frequently  seen  non-physiological  causes  include  drug-induced hyperprolactinaemia, polycystic ovarian syndrome, and benign prolactin-secreting tumours of the anterior pituitary gland (prolactinomas). Tumours may be classified as either micro- (<1cm  in  diameter), which  are  most  common, or  macroprolactinomas  (>1  cm  in  diameter). Prolactinomas  most  commonly  occur  in  women  between  30  and  50  years  of  age  and hyperprolactinaemia usually presents with galactorrhoea or symptoms of disturbed gonadal function (secondary amenorrhoea, anovulation, and infertility in women; erectile dysfunction, reduced  shaving  frequency  in  men).   Macroprolactinomas  may  also  present  with  local pressure effects (headache, visual fi eld loss).  Dopamine agonists, such as bromocriptine and cabergoline,  are  the  first-line  treatment  for  both  micro-  and  macroprolactinomas. Nowadays, surgical treatment is rarely required even for macroprolactinomas. The main aim of treatment is resolution of symptoms, and, therefore, restoration of gonadal function.  For patients with microprolactinomas, dopamine agonist treatment should be withdrawn for a trial period after two to three years, as in around one-third of cases the prolactin level will return  to  normal.  In  women  with  microprolactinomas  who  become  pregnant, dopamine agonists  should  be  discontinued  once  pregnancy  is  confirmed. For  women  with macroprolactinomas, bromocriptine can be continued throughout the pregnancy.