Hyperprolactinemia Patient Care and Monitoring

1. Assess patient's clinical signs and symptoms of hyperprolactinemia.

2. Review the available diagnostic data to determine severity and exclude other common causes of hyperprolactinemia.

3. Obtain a thorough medication history to exclude medication-induced hyperpro-lactinemia.

4. Determine patient's plan regarding pregnancy because this influences treatment.

5. Educate patient about safety and efficacy of dopamine agonists. Make sure that the patient does not have any contraindications or allergies to drug therapies.

6. Develop a formal plan to assess response and adverse effects of dopamine agonists. When appropriate, be sure to make dose adjustments.

7. If the prolactin level remains normal for 2 years, reassess the need to continue treatment. Make sure that the patient is taking the lowest effective dose for management of hyperprolactinemia.

8. Provide patient education in regard to disease state and nondrug and drug therapy. Discuss with the patient:

• Risk factors associated with hyperprolactinemia

• Potential disadvantages and effectiveness of existing dopamine agonist therapy

• Potential disadvantages and effectiveness of surgery and radiation treatment

• Importance of adherence to therapy

• Potential for adverse effects or long-term complications

• Evaluate visual fields in pregnant patients every 2 to 3 months.40

• If the prolactin level is well controlled with dopamine agonist therapy for 2 to 3 years, gradually taper therapy to the lowest effective dose. 0 Check prolactin levels after each dose reduction.

• If the prolactin levels remain unchanged for 1 year at the reduced dose, dopamine agonist therapy may be discontinued.

• It is essential to monitor prolactin levels every 6 months or annually to detect the possibility of permanent remission of pituitary disease.

• The need to continue dopamine agonists in postmenopausal women with micro-prolactinomas must be reassessed because these patients have a higher probability of maintaining normal prolactin levels after treatment is discontinued.40

• In patients with macroprolactinomas, monitor visual field at baseline and repeat the test 1 month after initiation of a dopamine agonist.

• Repeat the MRI 6 months after initiating therapy, or if an increase in symptoms, or rise in prolactin levels suggests the presence of tumor growth.43

• Discontinuation of therapy in patients with macropro-lactinomas usually leads to tumor regrowth and recurrence of hyperprolactinemia. This decision warrants careful consideration.

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