Galactorrhea, amenorrhea, ↓libido, bitemporal hemianopia
Confirm: Prolactin level → pituitary MRI
Treat: Cabergoline / bromocriptine (dopamine agonist) — first-line even for macroadenoma
Refractory / visual loss → transsphenoidal surgery
Order set
- Prolactin
- Pituitary MRI
- TFT, pregnancy test
- Visual fields (macro)
Criteria
AdmitApoplexy or visual compromise
DischargeDopamine agonist started, endocrine + fields follow-up
Clinical detail — differentials, red flags, pitfalls, disposition
Red flags
- Visual field defect
- Apoplexy
Differentials
- Drug-induced hyperprolactinaemia
- Pregnancy
- Hypothyroidism
- Stalk effect
Common mistakes
- MRI before excluding drugs/pregnancy
- Surgery first-line
Disposition & follow-up
Dopamine agonist first-line; surgery if refractory.
Discharge package
MedicationsDopamine agonist
Follow-upEndocrine; prolactin + fields + MRI
Warning symptomsVisual change, severe headache
💊 Treatment detail — doses & preparation
Cabergolinedopamine agonist
Dose0.25–0.5 mg twice weekly, titrate monthly (prolactinoma/acromegaly adjunct)
Preparation0.5 mg tablets with food
MonitorProlactin monthly, impulse-control disorders, cardiac valve (high cumulative dose)
Bromocriptinedopamine agonist
Dose2.5–15 mg/day divided (alternative; preferred if pregnancy planned)
Preparation2.5 mg tablets with food
MonitorNausea, orthostasis, impulse control
📖 Endocrine Society HyperprolactinaemiaReviewed July 2026