Clinical issues in diagnosis and treatment of hyperprolactinemia

Abstract:

Hyperprolactinemia is a common cause of secondary hypogonadism，which affects the reproductive function of both men and women. There are many challenges in the diagnosis and treatment of hyperprolactinemia. There is a ‘hook effect’ in the measurement of hormone levels，which underestimates the true level of hormone. Macroprolactinemia is characterized by asymptomatic or inconsistent high prolactin levels. In order to reduce misdiagnosis and missed diagnosis，attention should be paid to distinguish the three common causes of physiological，pathological or drug. Dopamine receptor agonist is the first-line treatment，but for patients with drug-resistant hyperprolactinemia，surgery，radiotherapy and other drug trials （such as temozolomide） should be selected after a comprehensive evaluation of the condition. Pregnancy is a period of increased physiological secretion of prolactin，and it is not recommended to use prolactin measurement to evaluate the disease during pregnancy. It is mainly determined by the tumor mass effect and critical condition to decide whether to start drug or surgical treatment. The diagnosis and treatment of resistant/refractory hyperprolactinemia and hyperprolactinemia during pregnancy are recommended under the support of an experienced multidisciplinary team.