Prolactin excess (prolactinoma and stalk effect)
Working through a raised prolactin (drugs, hypothyroidism, CKD, macroprolactin, stalk effect and the hook effect), when to image, cabergoline as first line even with visual loss, withdrawal, pregnancy and the side effects worth asking about.
Tier 2Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Raised prolactin is common, and most of it isn't a prolactinoma. Drugs, pregnancy, hypothyroidism, CKD and macroprolactin come first.
- Dopamine from the hypothalamus holds prolactin down. Anything that blocks dopamine or the stalk raises it (see Hypothalamic-pituitary anatomy and physiology).
- Symptoms come from hypogonadism: amenorrhoea, infertility, low libido, erectile dysfunction, low bone density. Galactorrhoea is less consistent.
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Sources
- Diagnosis and management of prolactin-secreting pituitary adenomas: a Pituitary Society international Consensus StatementPituitary Society (Petersenn et al., Nat Rev Endocrinol 2023;19:722-40), 2023
- Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guidelineEndocrine Society (Melmed et al., J Clin Endocrinol Metab 2011;96:273-88), 2011
- Echocardiography and monitoring patients receiving dopamine agonist therapy for hyperprolactinaemia: a joint position statementBritish Society of Echocardiography, British Heart Valve Society and Society for Endocrinology (Steeds et al., Echo Res Pract 2019;6:G1-G8), 2019
- Cabergoline 500 microgram: Restricted benefit, pathological hyperprolactinaemiaAU/NZPharmaceutical Benefits Scheme, 2026
- Endocrinology (Therapeutic Guidelines)AU/NZTherapeutic Guidelines Ltd
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Turnstile bot check on sign-in and signed-out feedback