Hyperprolactinemia: optimal algorithm of laboratory test

Abstract

The paper presents the modern laboratory aspects of diagnosis of hyperprolactinemia and monitors the effectiveness of treatment according to the Diagnosis and treatment of hyperprolactinemia: an Endocrine Society Clinical Practice Guideline, 2011.

Clinical picture of hyperprolactinemia determine the effect of high prolactin levels, and due to the effect of the tumor mass on surrounding structures: reproductive system disorders (menstrual dysfunction, infertility, galactorrhea in women, decreased libido, erectile dysfunction, impotence, changes in spermogramme, gynecomastia, infertility in men); the pressure of the tumor mass on surrounding structures causes headache, blurred vision (visual fields are loss and blurred vision); psycho-emotional disorders.

The high prevalence of hyperprolactinemic syndrome as an independent disease or syndrome accompanying other disease leads to the necessity of compulsory elimination of it in all cases of menstrual disorders, hyperandrogenic manifestations, infertility, galactorrhea. Particular attention should be paid to the combination with headaches, vision disorders (loss visual field). In infertile couples it should to exclude hyperprolactinemic syndrome in women and in most cases in men.

Laboratory test is the main method in the diagnosis and differential diagnosis – determining the prolactin level and macroprolactinemia exception. Increasing of prolactin level more than 25 ng/mL regardless of gender, make it possible to establish the diagnosis of hyperprolactinemia.

For prolactin level interpretation it is necessary to accounting factors (physiological and pharmacological) that can increase the hormone level. In case of normal or slightly elevated levels and macroadenoma evidence, you must test the prolactin level in the conduct of breeding conditions of 1: 100. Because hyperprolactinemic syndrome may be accompanied by a number of other diseases, it is necessary to determine the scope of the treatment to eliminate these pathologies for effective treatment.