Exclude secondary causes of hyperprolactinemia

Microadenoma

Macroadenoma

Dopamine agonist

Continue medication
May increase dose

Continue medication

Lower dose
Change medication
Intravaginal application
Consider surgery

Replace sex steroids

Titration of drug dose

Drug intolerance

Normal PRL
Sexual function restored
Tumor shrinkage

Reduction in PRL but still elevated
Sexual function restored
Tumor shrinkage

Reduction in PRL but still elevated
Sexual function not restored
Tumor shrinkage

End

Monitor PRL levels
Repeat MRI annually

Monitor PRL levels
Repeat MRI annually

Monitor PRL levels
Repeat MRI annually

Dopamine agonist

Assess pituitary reserve function

Test visual fields

Macroadenoma, inadequate response to medication

Repeat MRI in 4 mo

Surgery

Increase dose or switch medication

Surgery or radiotherapy rarely required for residual tumor

Surgery or radiotherapy rarely required for residual tumor

No tumor shrinkage or visual field not improved

PRL not reduced
No tumor shrinkage

PRL reduced
Tumor not smaller

Desires pregnancy

MRI, Magnetic resonance imaging; PRL, prolactin.