From the Guidelines
The next step in the workup of a young female with mildly elevated prolactin levels on two occasions should be to assess baseline macroprolactin levels to determine if the elevation is due to macroprolactinemia, a condition with low biological activity. This approach is based on the latest consensus guideline for the diagnosis and management of pituitary adenomas in childhood and adolescence, which strongly recommends assessing baseline macroprolactin levels in cases of mildly or incidentally elevated serum prolactin 1. Some key points to consider in this workup include:
- Macroprolactinemia is a condition where dimeric or polymeric forms of prolactin circulate in the blood, often associated with an antibody, and has low biological activity.
- Routine assays do not distinguish between monomeric prolactin and macroprolactin, making secondary analysis necessary to detect macroprolactin.
- The presence of macroprolactinemia can be found in 10-40% of individuals with hyperprolactinemia, and its detection can help avoid unnecessary further testing and treatment 1. The assessment of macroprolactin levels is a crucial step in the workup of mildly elevated prolactin levels, as it can help identify cases of macroprolactinemia and guide further management.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Next Steps in Workup
The next step in the workup of a young female with mildly elevated prolactin levels on two occasions involves several key considerations:
- Confirming the presence of hyperprolactinemia by ensuring the elevation is not due to conditions known to raise prolactin levels 2
- Ruling out macroprolactinemia and other identifiable non-tumoral causes of hyperprolactinemia 2
- Evaluating for symptoms suggestive of excess prolactin such as galactorrhea or menstrual cycle disorder 2
Diagnostic Approach
The diagnostic approach may include:
- Accurate determination of prolactin concentration 2
- Exclusion of macroprolactinemia 2
- Imaging procedures, such as magnetic resonance imaging (MRI), to determine the presence, size, and extent of any potential lesion 3, 4
- Evaluation for gonadal, thyroid, and adrenal function, as well as the secretion of other pituitary hormones 3
Treatment Considerations
Treatment considerations for mildly elevated prolactin levels include:
- Medical therapy with dopamine agonists, such as cabergoline, which is often the primary therapy for prolactin-secreting adenomas 4, 5
- The goal of treatment is to normalize prolactin levels, restore fertility, and reduce tumor size, if present 2, 5
- Cabergoline is generally preferred over bromocriptine due to its superior efficacy and tolerance 5