Chapter 18 - Treatment of hyperprolactinemia

Summary

Prolactin exerts many physiologic functions, perhaps the most prominent of which is inducing lobuloalveolar growth of the mammary gland, along with stimulation of lactogenesis or milk production after giving birth. The majority of prolactinomas contains only lactotroph cells and produce prolactin in excess. The major mechanism is a threefold increase in prolactin secretion, and a one-third decrease in metabolic clearance rate. Oligomenorrhea, amenorrhea, galactorrhea, infertility, hot flashes, vaginal dryness, headaches, and visual changes are clinical manifestations of hyperprolactinemia in premenopausal women. Women who have lactotroph microadenoma causing hyperprolactinemia and hypogonadism and cannot tolerate or do not respond to dopamine agonists and do not want to become pregnant can be treated with estrogen and progestin. Cabergoline is the most effective of the dopamine agonists but is the most expensive. Intravaginal administration of dopamine agonists reduces their side effects.