title: Clinical inquiries. What is the recommended evaluation and treatment for elevated serum prolactin?
abstract: History and physical examination can distinguish among most physiologic, pharmacologic, or pathologic causes of an elevated serum prolactin level (SPL) (strength of recommendation [SOR]: C, expert opinion). Patients with unexplained elevations of serum prolactin or with a level above 200 ng/mL should undergo imaging of the sella turcica (SOR: C, expert opinion). Mildly elevated SPL due to physiologic causes may be managed expectantly (SOR: B, cohort studies) and pharmacologic elevations may be treated by discontinuing the causative medication (SOR: C, expert opinion). Elevated SPL due to pathologic causes requires both monitoring for complications and treatment of the underlying condition (SOR: C, expert opinion). Dopamine agonists are effective for patients requiring drug treatment (SOR: B, systematic review of cohort studies), and cabergoline is more effective and better tolerated than bromocriptine (SOR: B, randomized controlled trial [RCT]). Surgery is reserved for symptomatic patients not controlled medically (SOR: C, expert opinion).
authors.affiliation: University of Washington, Seattle, WA, USA.
authors.forename: Jo
authors.initials: J
authors.lastname: Jackson
authors.forename: Sarah
authors.initials: S
authors.lastname: Safranek
authors.forename: Allen
authors.initials: A
authors.lastname: Daugird
mesh_terms: D019317:Evidence-Based Medicine; D006727:Hormone Antagonists / Q000627:therapeutic use*; D006801:Humans; D006966:Hyperprolactinemia / Q000097:blood / Q000175:diagnosis* / Q000628:therapy*; D010902:Pituitary Gland / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D011388:Prolactin / Q000097:blood*; D011859:Radiography; D012658:Sella Turcica / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery
chemical_list: D006727:Hormone Antagonists; D011388:Prolactin