Hyperprolactinemia is a condition characterized by the presence of abnormally high circulating levels of the hormone prolactin. Prolactin is primarily associated with lactation and plays a vital role in breast milk development during and after pregnancy. Prolactin can become too high because of a disease or the use of certain medications and often, the cause is a prolactin-making tumor of the pituitary gland, called a prolactinoma. Both men and women with high prolactin levels may have infertility, low sex drive and bone loss. Women with hyperprolactinemia may also experience absent or irregular menstrual periods.
“People with high prolactin levels who have few or no symptoms and no demonstrable pituitary tumor may not need treatment, but infertile or pregnant patients, and individuals with bothersome symptoms require specialized treatment depending on the cause of their condition,” said Shlomo Melmed, MD, chair of the task force that authored the CPG and dean at Cedars-Sinai Medical Center in Los Angeles, Calif. “This new Clinical Practice Guideline helps clinicians diagnose hyperprolactinemia, identify the most appropriate treatment and manage prolactinomas in non-pregnant and pregnant individuals.”
Recommendations from the CPG include:
- A single measurement of serum prolactin to establish the diagnosis of hyperprolactinemia with a level above the upper limit of normal confirming the diagnosis as long as the serum sample was obtained without excessive venipuncture (the process of obtaining intravenous access) stress;
- Discontinued use of dynamic testing of prolactin secretion for the diagnosis of hyperprolactinemia;
- Dopamine agonist therapy to lower prolactin levels, decrease tumor size and restore gonadal function for patients harboring symptomatic prolactin-secreting microadenomas and macroadenomas (dopamine agonists activate production of the hormone dopamine); and
- Awareness of multiple medications which may lead to elevated prolactin levels.
The Hormone Foundation, the patient education affiliate of The Endocrine Society, has published a companion patient guide to this CPG. The patient guide, which can be found online at http://www.hormone.org/Pituitary/upload/Hyperprolactinemia-Patient-Guide-WEB.pdf, defines the effects of hyperprolactinemia and explains how the condition is diagnosed and treated in both non-pregnant and pregnant patients.
Other members of The Endocrine Society task force that developed this CPG include: Felipe Casanueva of the University of Santiago de Compostela in Spain; Andrew Hoffman of VA Palo Alto Health Care System in Palo Alto, Calif.; David Kleinberg of the New York University School of Medicine in New York; Victor Montori of Mayo Clinic Rochester in Minn.; Janet Schlechte of the University of Iowa in Iowa City; and John Wass of Churchill Hospital in Oxford, United Kingdom.
The Society established the Clinical Practice Guideline (CPG) Program to provide endocrinologists and other clinicians with evidence-based recommendations in the diagnosis and treatment of endocrine-related conditions. Each CPG is created by a task force of topic-related experts in the field. Task forces rely on scientific reviews of the literature in the development of CPG recommendations. The Endocrine Society does not solicit or accept corporate support for its CPGs. All CPGs are supported entirely by Society funds.
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Founded in 1916, The Endocrine Society is the world’s oldest, largest, and most active organization devoted to research on hormones and the clinical practice of endocrinology. Today, The Endocrine Society’s membership consists of over 14,000 scientists, physicians, educators, nurses and students in more than 80 countries. Together, these members represent all basic, applied, and clinical interests in endocrinology. The Endocrine Society is based in Chevy Chase, Md. To learn more about the Society, and the field of endocrinology, visit our web site at www.endo-society.org.