Additional Clinical Sequelae

• The prolonged suppression of estrogen in premenopausal women with hyperprolact-inemia leads to decreases in bone mineral density and significant risk for the development of osteoporosis.

• Risk for ischemic heart disease may be increased with untreated hyperprolactin-emia.

Adapted, with permission, from Sheehan AH, Yanovski JA, Calis KA. Pituitary gland disorders. In: Dipiro

JT, Talbert RL, Yee GC, et al., eds. Pharmacotherapy. A Pathophysiologic Approach. 7th ed. New York:

McGraw Hill, 2008:1291.

• Prevent progression of pituitary tumor or hypothalamic disease General Approaches to Treatment

Management of drug-induced hyperprolactinemia is to discontinue the offending agent, if possible, and start an appropriate therapeutic alternative. In situations where the offending agent cannot be discontinued, cautious use of hormone replacement, bi-phosphonate therapy, and/or dopamine agonists may be considered depending on the patient's clinical circumstances. 4 Treatment options for the management of hyperprolactinemia include: (a) clinical observation; (b) pharmacologic therapy with dopamine agonists; (c) transsphenoidal pituitary adenomectomy; and (d) radiation therapy. Figure 46-4 outlines an approach to the management of hyperprolactinemia after excluding drug-induced causes and other etiologies (e.g., hypothyroidism, renal failure, hepatic dysfunction). Clinical observation and close monitoring are justifiable in patients with asymptomatic elevation of prolactin. Dopamine agonists are the firstline treatment of choice for all patients with hyperprolactinemia; transsphenoidal surgery and radiation therapy are reserved for patients who are resistant to or severely intolerant of pharmacologic therapy.39

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