What is the role of hormone testing in the workup of prolactinomas?

Updated: Mar 25, 2018
  • Author: Venkatesh Babu Segu, MD, MBBS, DM; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Hormone testing

Serum PRL

Measure serum PRL levels on 1 or more occasions, especially if the elevation is modest. Do not measure the PRL level directly after performing a breast examination, because the breast examination may cause a physiological PRL elevation.

Serum pregnancy test

Always consider the possibility of pregnancy in reproductive-aged females, because this is the most common cause of secondary amenorrhea in this group.

Serum TSH

Measure TSH levels to exclude the possibility of an elevated PRL level occurring secondary to an elevated TRH level. TRH is one of the PRFs. If the TSH level is elevated, confirm the finding by measuring the free thyroxine level. [23]

Measurement of other pituitary hormones

In a male presenting with symptoms of hypogonadism, measure serum testosterone or bioavailable testosterone levels.

In a patient with a history suggestive of adrenal insufficiency, measure basal and cosyntropin-stimulated cortisol levels.

In a person with features consistent with acromegaly, measure serum insulinlike growth factor-1 levels.

Exclude other possible systemic causes for hyperprolactinemia, such as chronic renal failure or cirrhosis, using appropriate laboratory tests as warranted.

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