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Serum prolactin is the definitive test for diagnosing hyperprolactinaemia.1
Assessment of serum prolactin is usually straightforward and informs the need for further workup.1,2
Normal value
Elevated value
• Refer to other laboratory results and the medical history to identify a secondary cause of hyperprolactinemia (eg, hypothyroidism, medications)
• Imaging may be needed to identify presence of a pituitary or hypothalamic mass
Elevated value, typically indicative of a prolactinoma
• Consider MRI scan and/or referral to a neuroendocrinologist
Aside from prolactin measurement, several other laboratory tests should be conducted during the workup of a patient with suspected hyperprolactinaemia as part of the differential diagnosis and to help identify a cause of hyperprolactinaemia, if present.1,2,4
• Recommended for patients with asymptomatic hyperprolactinemia
• Macroprolactinemia is a common cause of hyperprolactinaemia; however, many commercial assays do not detect large polymeric forms of prolactin (i.e., macroprolactin)
• Mandatory for any woman of childbearing age with amenorrhoea to identify possible pregnancy
• In patients with hyperprolactinaemia, levels are reduced due to prolactin interference with GnRH (gonadotropin-releasing hormone) secretion, leading to hypogonadism and infertility
• Useful for determining primary hypothyroidism, which can cause mild hyperprolactinaemia
• Normalization of thyroid function with levothyroxine leads to hyperprolactinaemia resolution
• Required for all patients with macroadenomas to identify possible acromegaly
• Useful for determining kidney dysfunction, which can cause prolactin to accumulate due to decreased clearance and enhanced production
• Useful for determining hepatic insufficiency, which can cause prolactin to accumulate due to decreased clearance
References
Determine therapy based on clinical and patient factors
Learn how to tailor therapy based on follow-up testing
See general information including pathophysiology and etiology
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PP-PFE-GBR-3863. November 2021