Hyperprolactinemia

Hyperprolactinemia is a common reason for referral to pediatric endocrinology, and possible causes of hyperprolactinemia range from benign physiological elevations to sellar or suprasellar tumors. Prolactin is high in infants for the first 3 months of life and is also elevated during stress, pregnancy, and lactation. Whereas mild elevations in prolactin in children may resolve with repeat testing or may be due to macroprolactinemia or medication effects, prolactinoma is also a common cause of hyperprolactinemia in the pediatric age group. Prolactinomas are unique among pituitary adenomas in that they usually can be managed successfully through medical therapy with dopamine agonists, although neurosurgery or other second-line therapies may be necessary for large aggressive tumors. Other less common etiologies of pediatric hyperprolactinemia include other sellar or suprasellar masses, primary hypothyroidism, and advanced renal or liver disease. This chapter discusses the physiology of prolactin secretion, the etiologies of pediatric hyperprolactinemia, the appropriate evaluation of hyperprolactinemia depending on clinical context, and the management of prolactinomas.