Guidelines recommend treatment with dopamine agonist therapy, discourage dynamic testing
MONDAY, Feb. 21 (HealthDay News) -- One serum blood test is sufficient to diagnose hyperprolactinemia, and dynamic testing of prolactin secretion should be avoided, according to new guidelines published in the February issue of the Journal of Clinical Endocrinology & Metabolism.
Shlomo Melmed, M.D., from the Cedars Sinai Medical Center in Los Angeles, and Endocrine Society colleagues used the GRADE system -- grading of recommendations, assessment, development, and evaluation -- to analyze recommendations and level of evidence. Clinical practice guidelines for diagnosis and treatment of hyperprolactinemia were reviewed.
The guidelines recommend a single measurement of serum prolactin to diagnose hyperprolactinemia, with a level above the normal limit confirming diagnosis. Dynamic testing of prolactin secretion is not recommended. Following diagnosis, the cause should be established by excluding medication use and pituitary and parasellar tumors. In suspected drug-induced hyperprolactinemia, the drug should be discontinued or replaced. In patients with symptomatic prolactin-secreting microadenomas or macroadenomas, dopamine agonist therapy, preferably cabergoline, can reduce prolactin levels and treat other symptoms. For symptomatic patients whose prolactin levels cannot be reduced, the guidelines suggest increasing the medication before referring a patient for surgery. Pregnant women should discontinue dopamine agonist therapy as soon as possible, and should avoid serum prolactin measurements.
"Testing for hyperprolactinemia is straightforward, owing to the ease of ordering a serum prolactin measurement. Accordingly, an evidence-based, cost-effective approach to management of this relatively common endocrine disorder is required," the authors write.
Several authors disclosed financial relationships with pharmaceutical and medical device companies, including Pfizer and Novartis.
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