DIAGNOSTIC PROTOCOLS FOR HYPERPROLACTINEMIA: CLINICAL INVESTIGATION AND LABORATORY CONFIRMATION

Abstract

Hyperprolactinemia (HPRL) is a common endocrinopathy characterized by elevated prolactin secretion resulting from reduced tonic dopaminergic inhibition. Clinically, it manifests with symptoms of hypogonadism and galactorrhea and shows a high prevalence among patients undergoing antipsychotic therapy. The objective of this study was to synthesize and critically analyze contemporary guidelines related to the diagnostic and management protocols of HPRL. A narrative literature review was conducted using indexed databases (PubMed and Cochrane Library), employing descriptors such as “Hyperprolactinemia,” “Diagnosis,” and “Treatment,” with emphasis on publications from the last five years. The diagnostic protocol requires a systematic approach, prioritizing the exclusion of physiological and pharmacological causes before investigating prolactinomas, with pituitary magnetic resonance imaging (MRI) reserved for cases in which drug-induced etiology cannot be discontinued. Once HPRL is confirmed, dopamine agonists represent the first-line therapy, with cabergoline considered the agent of choice due to its superior efficacy (approximately 95% biochemical normalization) and better tolerability profile. For antipsychotic-induced HPRL in patients for whom switching the primary medication is not feasible, the addition of low-dose aripiprazole (5 mg/day to 10 mg/day) has demonstrated a highly effective and safe strategy for prolactin normalization and symptomatic reversal. These guidelines reinforce the need for rigorous clinical screening and management to mitigate long-term risks associated with chronic HPRL.