[Hyperprolactinemia: etiology, clinical symptoms, and therapy]

Hyperprolactinemia is one of the most common endocrinological disorders. The main clinical symptoms are limited to hypogonadism, which manifests as fertility disturbances, oligo- or amenorrhea in women, and libido loss, impotence, and fertility disturbances in men, as well as bone density disturbances (osteopenia, osteoporosis) and alactorrhea. Hyperprolactinemia is caused in most cases by drugs or it has an organic etiology (pituitary tumor:--prolactinoma). Differentiation between these two causes is very important for both therapeutic decisions and prognosis. In the medical treatment of a hyperprolactinemic condition dopamine receptors type D2 agonists are used. Such drugs have well-established high therapeutic efficiency (in the vast majority of patients they cause normalization of PRL serum level, tumor shrinkage, and withdrawal of the hyperprolactinemia-related symptoms and tumor mass). This is why they are the first line treatment for prolactinoma. In cases of a lack of pharmacological effect, drug intolerance or resistance, large tumors with accompanying compression symptoms' (tumor mass effect), dynamic tumor enlargement, or if a macroprolactinoma-affected woman desires pregnancy neurosurgery should be considered. Radiotherapy is used mainly as a supplement to surgical treatment.