Recommendations from others
Williams Textbook of Endocrinology includes the recommendations above and advises seeking consultation for patients with mass effects of macroadenomas such as visual field loss, cranial nerve palsy, or headaches; for patients with progressive elevation of SPL despite medical treatment; and for pregnant women.4 Conventional antipsychotic agents are commonly associated with elevated prolactin due to dopamine agonist activity. Some atypical antipsychotics may lead to lower levels of elevated prolactin, transient elevations or marked elevations.10 Experts recommend following serial SPLs, if antipsychotics are truly needed. Psychiatric consultation may assist in making decisions about medication selection. Patients with symptoms (galactorrhea, amenorrhea, headaches, visual disturbances, sexual dysfunction) or levels of 200 or more, should undergo an MRI or CT. Experts recommend monitoring levels every 1 to 3 months.1
TABLE
Physiologic, pharmacologic, and pathologic causes of an elevated serum prolactin level1
| PHYSIOLOGIC |
| Pregnancy |
| Ectopic pregnancy |
| Lactation |
| Nipple stimulation |
| Stress |
| Sleep disorder |
| PHARMACOLGIC |
| Dopamine receptor antagonists: phenothiazines, butyrophenones, thioxanthene, risperidone, metoclopramide, sulpiride, pimozide |
| Dopamine-depleting agents: α-methyldopa, reserpine |
| Hormones: estrogens, antiandrogens |
| Others: danazol, isoniazid, verapamil, cyproheptadine, opiates, H2-blockers (cimetidine), cocaine and marijuana, tricyclic antidepressants |
| PATHOLOGIC |
| Acromegaly |
| Alcoholic cirrhosis |
| Chest wall trauma or tumor |
| Herpes zoster |
| Hypothalamic and pituitary stalk disease |
| Hypothyroidism |
| Pituitary tumors: prolactinomas, adenomas |
| Polycystic ovarian syndrome |
| Renal failure |
| Sarcoidosis |