Idiopathic Unknown

a Atypicals (olanzapine and clozapine) other than risperidone may cause an early but transient elevation in prolactin.

Adapted in part, 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.

In combination with clinical symptoms, at least three repeated measures of serum prolactin levels greater than 20 ng mL (20 mcg/L) are needed to confirm the diagnosis. A number of physiologic factors such as eating, exercise, and stress can transiently elevate prolactin levels.8 Therefore, prolactin measurements should be obtained at rest, preferably in the morning under fasting conditions.39 If an IV line is present or planned, it is prudent to wait at least 2 hours after line insertion before measuring serum prolactin to decrease detecting transient physiologic increases in prolactin level39,42 (Table 46-4). Medication-induced hyperprolacti-nemia typically is associated with prolactin levels of less than 150 ng/mL (150 mcg/L), whereas prolactin levels greater than 250 ng/mL (250 mcg/L) are almost always associated with macro-

prolactinoma.43

Treatment Goals for Hyperprolactinemia

Because hyperprolactinemia is often associated with hypo-gonadism, the goals for management of hyperprolactinemia are to restore the clinical consequences of hypo-gonadism and reduce its associated risk for osteoporosis, as follows4 :

• Normalize prolactin level

• Improve clinical symptoms

• Restore normal fertility

• Restore and maintain normal gonadal function

• Protect against development of osteoporosis

• Prevent disease recurrence

• If a pituitary tumor is present:

• Ablate or reduce tumor size to relieve tumor mass effect

• Preserve normal pituitary function

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