How should I manage a patient with galactorrhoea who has elevated prolactin levels?

Management of a patient presenting with galactorrhoea and elevated prolactin levels begins with confirming the diagnosis by repeating serum prolactin measurement to exclude transient elevations and ensuring the sample is taken without stress or recent exercise, as these can falsely elevate levels NICE NG132. A detailed clinical history and examination should identify potential causes such as medications, hypothyroidism, or pituitary disorders NICE NG132. Initial investigations should include thyroid function tests and renal function to exclude secondary causes NICE NG132. If prolactin remains elevated, magnetic resonance imaging (MRI) of the pituitary gland is indicated to assess for prolactinoma or other sellar masses NICE NG132. Management depends on the underlying cause: if a prolactinoma is identified, dopamine agonists (e.g., cabergoline) are first-line treatment to reduce prolactin levels and tumour size, and to resolve galactorrhoea NICE NG132. If medication-induced hyperprolactinaemia is suspected, review and adjust offending drugs if possible NICE NG132. In cases without an identifiable cause or with mild elevation, observation and symptomatic treatment may be appropriate NICE NG132.

In patients with mental illness, hyperprolactinaemia may be exacerbated by antipsychotic medications, which block dopamine receptors, leading to elevated prolactin and galactorrhoea; thus, collaboration with psychiatry to consider alternative agents or dose adjustments is important Carvalho & Góis 2011. This highlights the need for a multidisciplinary approach in such cases to balance psychiatric stability and endocrine side effects Carvalho & Góis 2011. Overall, the UK guideline approach emphasises systematic evaluation and targeted treatment, while recent literature underscores the importance of considering psychiatric medication effects in hyperprolactinaemia management Carvalho & Góis 2011 NICE NG132.