Hyperprolactinemia in Older Adults: A Narrative Review of Distinct Clinical Challenges and Management Strategies

Hyperprolactinemia in older adults represents a significant diagnostic and therapeutic challenge, as its manifestations can often be masked by symptoms typically associated with normal aging. Unlike in younger populations, the primary cause of this condition in the elderly is the use of medications, such as antipsychotics, antiemetics, and prokinetics. The clinical presentation of excessive prolactin production in the elderly varies significantly, and the diagnostic approach requires a high index of clinical suspicion and a thorough review of potentially involved medications. Management must be individualized, carefully selecting candidates for dopamine agonist therapy or, in cases of pituitary adenomas, surgical or radiotherapeutic management. This review synthesizes the evidence on these atypical presentations and the nuances of management tailored to the older adult.