Hyperprolactinemia in Women

Hyperprolactinemia is one of the most common indications of pituitary MRI in young women. Iatrogenic hyperprolactinemia is frequent and must be detected. Knowledge of the exact prolactin level is essential. Demonstration of a prolactin PitNET is almost never seen when this level is below 35 micrograms per liter, i.e., 700 milliunits per mL. There is a good correlation between prolactin level and prolactinoma size, except when the adenoma is hemorrhagic or necrotic. Most microprolactinomas are more or less T2W hyperintense and this hyperintensity increases with cabergoline while the adenoma size decreases. For follow-up after treatment with dopaminagonist, gadolinium injection is unnecessary and must be spared. Persistence of a focal T2 hyperintensity after years is the rule even in cured microprolactinomas. Macroprolactinomas which are rarer than in men can invade the cavernous sinus.