Following patients under treatment for hyperprolactinemia

Management of patients receiving treatment for hyperprolactinemia depends on a few specific parameters: whether the patient has no pituitary lesion, a pituitary microadenoma or a pituitary macroadenoma. In each of these categories, management will differ depending on whether the patient desires to become pregnant. Some patients with hyperprolactinemia who are asymptomatic may be managed expectantly, with periodic measurement of serum prolactin levels and careful monitoring for emergence of symptoms. In the vast majority of cases, treatment with a dopamine agonist is appropriate and effective. If pregnancy is desired, efforts should be made to time it carefully and to discontinue the drug as soon as a pregnancy test is positive. Only patients with macroadenomas who do not respond adequately to medical therapy and show signs of a cranial mass effect from the lesion should be referred for neurosurgical evaluation.