Raised prolactin levels or Hyperprolactinemia

Authored by Partha Kar, published on 2026-04-27 18:50:05.0

The algorithm is broadly aligned with contemporary hyperprolactinaemia care: confirm true elevation, exclude physiologic/secondary/drug causes (including macroprolactin), proceed to pituitary MRI when persistent, and treat symptomatic prolactinomas primarily with dopamine agonists (cabergoline preferred). It appropriately places transsphenoidal surgery as second-line for intolerance/resistance or urgent complications and includes reasonable follow-up and consideration of dopamine-agonist withdrawal after sustained remission. Overall, it reflects major Endocrine Society/Pituitary Society recommendations, though some thresholds and follow-up intervals may vary by guideline and local practice.

  1. CONFIRM DIAGNOSIS
    • Persistent elevation → Pituitary MRI
      • CAUSES AFTER MRI
        • TREAT OR OBSERVE?
          • FIRST-LINE TREATMENT
            • WHEN TO CONSIDER SURGERY
              • FOLLOW-UP
                • STOP TREATMENT?
                  • COMPLICATIONS TO ADDRESS
          • OBSERVE
            • FOLLOW-UP
              • STOP TREATMENT?
                • COMPLICATIONS TO ADDRESS
  2. RULE OUT COMMON CAUSES (ALWAYS FIRST) “P-MHTS”
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