Hyperprolactinemia in women: diagnostic approach

Keypoints Hyperprolactinemia (HPRL) is a cause of menstrual irregularity, galactorrhea, hypogonadism and infertility. Serum prolactin measurement should only be performed in the presence of compatible symptoms and/or in the presence of a pituitary tumor, even with an incidental diagnosis.Dosage is not recommended as a routine examination. There are several causes of HPRL.In most cases, it is caused by pregnancy, hypothalamic-pituitary disconnection or PRL-secreting pituitary adenomas (prolactinomas), or it can also be secondary to the use of medications. Recognizing clinical, laboratory and imaging findings is essential for the diagnosis of prolactinoma, and its differential diagnoses. Recommendations Hyperprolactinemia is a condition with diverse etiologies, and its correct identification is essential for the proper treatment and monitoring. Mild hyperprolactinemia should be confirmed with a new measurement after excluding venipuncture stress. Macroprolactin testing is indicated in patients with asymptomatic hyperprolactinemia. If drug-induced hyperprolactinemia is suspected, a new serum prolactin measurement is recommended three days after discontinuation of the drug, when withdrawal is possible.If there is a contraindication and doubt regarding the etiology, pituitary imaging should be performed. Sellar imaging by magnetic resonance, ideally, or computed tomography if the former is unavailable, should only be done after excluding other causes of HPRL.When sellar imaging is suggestive of a pituitary tumor, evaluate if the size of the lesion and prolactin levels point to the presumptive diagnosis of prolactinomas.