When confronted with patients suffering from moderate hyperprolactinemia (25-100μg/L) in daily practice, multiple causes should be evoked. If the condition is not associated with suggestive symptoms, it is most often caused by other conditions than a prolactinoma. These mainly include transient hyperprolactinemia that is not confirmed by subsequent hormonal testing, macroprolactinemia that must always be systematically ruled out; antidopaminergic or serotoninergic drugs leading to a sustained rise in prolactin concentrations (mainly neuroleptics and antiemetics), and disconnection hyperprolactinemia associated with other lesions of the hypothalamic-pituitary axis disrupting the dopaminergic inhibitory control on basal prolactin secretion. We have herein reviewed the different causes of hyperprolactinemia. Before embarking the patient on a long-term treatment with dopamine agonists, the diagnostic evaluation should always take into consideration these potential causes, in addition to a possible pituitary incidentaloma.
Prolactin, neuroleptics, macroprolactinemia, prolactinoma, pituitary tumour