Clinical inquiries. What is the recommended evaluation and treatment for elevated serum prolactin?

Author(s): Jackson J, Safranek S, Daugird A

Affiliation(s): University of Washington, Seattle, WA, USA.

Publication date & source: 2005-10, J Fam Pract., 54(10):897-8, 901.

Publication type: Review

History and physical examination can distinguish among most physiologic, pharmacologic, or pathologic causes of an elevated serum prolactin level (SPL) (strength of recommendation [SOR]: C, expert opinion). Patients with unexplained elevations of serum prolactin or with a level above 200 ng/mL should undergo imaging of the sella turcica (SOR: C, expert opinion). Mildly elevated SPL due to physiologic causes may be managed expectantly (SOR: B, cohort studies) and pharmacologic elevations may be treated by discontinuing the causative medication (SOR: C, expert opinion). Elevated SPL due to pathologic causes requires both monitoring for complications and treatment of the underlying condition (SOR: C, expert opinion). Dopamine agonists are effective for patients requiring drug treatment (SOR: B, systematic review of cohort studies), and cabergoline is more effective and better tolerated than bromocriptine (SOR: B, randomized controlled trial [RCT]). Surgery is reserved for symptomatic patients not controlled medically (SOR: C, expert opinion).