A rational approach to the evaluation and management of patients with hyperprolactinemia

Prolactin has multiple biological functions. Hyperprolactinemia is a common condition in clinical practice both in women and men. It has multiple etiologies and may present with variable symptoms to different health-care providers. Therefore, a rational and systematic approach is paramount when evaluating patients with hyperprolactinemia to arrive at the correct diagnosis and institute the appropriate therapy. We here review the etiology, clinical presentation, and differential diagnosis of hyperprolactinemia and present a practical plan for further evaluation and management. It is most essential to establish the diagnosis and need for the treatment of patients with micro- and macro-prolactinomas and identify when only observation may be warranted. The biological, medical, and social contexts have to be considered to make the appropriate management decisions on an individual basis.