Hyperprolactinemia, galactorrhea, and pituitary adenomas

Abstract

Pituitary adenomas, hyperprolactinemia, and galactorrhea are disorders which can occur concomitantly or independently. In the following chapter, we will discuss the differential, signs and symptoms, and diagnosis of these diseases. Pituitary adenomas are classified by their size with less than 1 cm being a microadenoma and equal to or greater than 1 cm being a macroadenoma. They can be additionally delineated as functioning versus nonfunctioning based on their hormone production status. Prolactin is synthesized in the pituitary and is primarily controlled by suppression with dopamine. Elevations may be due to many causes including prolactinomas, stalk compression, medications, or hypothyroidism. Galactorrhea may be due to prolactin elevations or may be unrelated. The chapter includes a discussion of both medical and surgical therapy options as well as a discussion regarding management during pregnancy. Generally, medical therapy involves treatment with dopamine agonists to suppress prolactin, although hormonal therapy with combined oral contraceptives or cyclic progestin is a reasonable alternative. In patients that are resistant to first time medications at their maximum dose, surgical management should be considered.