7 Hyperprolactinaemia V.K.B. Prabhakar MBBS, MRCP(UK) Specialist Registrar J.R.E. Davis * MD, PhD, FRCP Professor of Medicine Department of Endocrinology, Manchester Royal Infirmary, Manchester M13 9WL, UK Hyperprolactinaemia is a frequent cause of reproductive problems encountered in clinical practice. A variety of pathophysiological conditions can lead to hyperprolactinaemia; therefore, pregnancy, drug effects, hypothyroidism and polycystic ovary syndrome should be excluded be- fore investigating for prolactin-secreting pituitary tumours. Prolactinomas are mainly diagnosed in women aged 20–40 years. They present with clinical features of hyperprolactinaemia (galac- torrhoea, gonadal dysfunction), and more rarely with large tumours, headache and visual field loss due to optic chiasm compression. Medical therapy with dopamine agonists is the treatment of choice for both micro- and macroprolactinomas. Tumour shrinkage and restoration of go- nadal function are achieved in the majority of cases with dopamine agonists. A trial of withdrawal of medical therapy may be considered in many patients with close follow-up. Pituitary surgery and radiotherapy currently have very limited indications. Pregnancies in patients with prolactino- mas need careful planning and close monitoring. Key words: dopamine agonists; hyperprolactinaemia; pituitary; prolactin; prolactinomas. The term ‘hyperprolactinaemia’ refers to an increase in circulating prolactin (PRL) levels, and is a frequent cause of reproductive problems, particularly anovulatory infer- tility in women. It is the most common pituitary hormone abnormality seen in clinical practice. In this review, current knowledge about the biology of PRL will be outlined briefly, followed by a discussion of the causes, clinical features and current manage- ment of hyperprolactinaemia. * Corresponding author. Tel.: þ44 (0)161 275 5181; Fax: þ44 (0)161 275 5958. E-mail address: julian.davis@manchester.ac.uk (J.R.E. Davis). 1521-6934/$ - see front matter ª 2007 Elsevier Ltd. All rights reserved. Best Practice & Research Clinical Obstetrics and Gynaecology Vol. 22, No. 2, pp. 341–353, 2008 doi:10.1016/j.bpobgyn.2007.08.002 available online at http://www.sciencedirect.com