HYPERPROLACTINEMIA

What's the best approach to hyperprolactinemia?

By Whitney S. Goldner, MD, and Janet A. Schlechte, MD

The dopamine agonists cabergoline and bromocriptine have replaced surgery for prolactinomas, a key cause of infertility. Two experts share their protocols for treating these benign tumors and explain which drug to choose when pregnancy is the goal—and which better restores menses.

Prolactinomas are benign prolactin-secreting pituitary tumors and the cause of amenorrhea in about 1 out of every 5 young women with that condition.¹ Fortunately, most tumors in women are small intrasellar masses (microadenomas) that don't grow progressively larger and rarely lead to headaches, neurologic dysfunction, or hypopituitarism.^2-5 Hyperprolactinemia occurs because the tumor oversecretes prolactin (PRL). The PRL secretion in turn interferes with pulsatile secretion of gonadotropin-releasing hormone and inhibits estrogen production, wreaking havoc with the menstrual cycle, and leading to hypogonadism and infertility.

The classic features of hyperprolactinemia are amenorrhea, galactorrhea, and infertility, but galactorrhea may occur alone, and some women with hyperprolactinemia have oligomenorrhea or regular menses.⁶ The low estrogen levels accompanying prolactinomas may also lead to osteopenia.⁷ The diagnosis of a prolactinoma is confirmed by the sustained elevation of serum prolactin and the presence of a pituitary tumor on MRI (Figure 1).