Clinical impact of hyperprolactinaemia

Prolactinomas are benign, functioning pituitary tumours that cause reproductive dysfunction in men and women. PRL-secreting microadenomas have a benign clinical course and may even disappear without treatment. Absolute indications for treatment of hyperprolactinaemia include the need to restore fertility and the presence of a macroadenoma. A dopamine agonist is the treatment of choice regardless of tumour size and will normalize PRL and restore menses in the majority of cases. Hypogonadism induced by hyperprolactinaemia is associated with decreased spinal bone mineral content, but it is not clear whether the bone loss is progressive. Bone mass improves after treatment of the hyperprolactinaemia but does not normalize. The safety of chronic oestrogen therapy in women with hyperprolactinaemic amenorrhoea who are not desirous of fertility remains to be elucidated by ongoing clinical trials.