Prolactinoma (high prolactin)Refer

• Cabergoline (first-line), Bromocriptine (if cabergoline not tolerated)

• Exclude other causes first: Pregnancy test, TSH, creatinine; drugs (antipsychotics, metoclopramide, domperidone, antidepressants); macroprolactin if no symptoms; MRI pituitary + visual fields once confirmed (Pituitary Soc 2023)

First visit

• Serum prolactin — Repeat if mildly raised; avoid stress and breast stimulation before the test.
• Urine pregnancy test, TSH, creatinine — Common causes of high prolactin.
• Medication review — Antipsychotics, metoclopramide, domperidone.

Only if indicated

• MRI pituitary — Prolactin raised without a drug or other cause.
• Visual fields — Macroadenoma.
• Macroprolactin — High prolactin without symptoms.

Follow-up and monitoring

• Prolactin — Every 3–6 months on cabergoline; echo if long-term high doses.