Hyperprolactinemia and Preconception Management

Prolactinoma is the most common pituitary tumor. Clinically, hyperprolactinemia is manifested as galactorrhea, amenorrhea, or oligomenorrhea, low libido, infertility, decreased bone density, or fractures. Other causes of hyperprolactinemia include pregnancy, medication induced, hypothalamic–pituitary stalk dysfunction, hypothyroidism, and renal insufficiency. Patients with hyperprolactinemia should be evaluated by thyroid-stimulating hormone (TSH), prolactin (PRL), renal function, human chorionic gonadotropin (hCG), and a careful history of medication use. A brain magnetic resonance imaging (MRI) should also be done as clinically indicated. Treatment of hyperprolactinemia is dependent on the underlying causes and symptoms. Prolactinomas are usually treated with dopamine (DA) agonists, while surgery and radiation are rarely required. Microprolactinomas causing non-bothersome galactorrhea without infertility can be monitored without intervention. Hypogonadism and low bone density should also be treated if these disorders still exist after correction of hyperprolactinemia.