# Hyperprolactinaemia (Evaluation & Management) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Endocrine Society Guideline on Pituitary Tumors 2011 · Egyptian National Drug Formulary - Endocrine System 2024 (bromocriptine monograph) - Verified date: 2026-08 ## Verified against - Endocrine Society Guideline on Pituitary Tumors 2011 - Egyptian National Drug Formulary - Endocrine System 2024 (bromocriptine monograph) - Hyperprolactinaemia (Evaluation & Management) - disease-level clinical article (hyperprolactinaemia-referral-full.txt) ## Treatment metadata - Cabergoline — 0.5 mg — oral.solid - Referral & safety-netting (no drug therapy) - Bromocriptine — 2.5 mg — oral.solid ## Complete treatment card ```text HYPERPROLACTINAEMIA (EVALUATION & MANAGEMENT) Sources: Endocrine Society Guideline on Pituitary Tumors 2011 · Egyptian National Drug Formulary - Endocrine System 2024 (bromocriptine monograph) Review status: REVIEWED against Endocrine Society Guideline on Pituitary Tumors 2011, Egyptian National Drug Formulary - Endocrine System 2024 (bromocriptine monograph), Hyperprolactinaemia (Evaluation & Management) - disease- level clinical article (hyperprolactinaemia-referral-full.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (7) - A pituitary mass can present with headache along with visual field loss, blurred vision, or reduced visual acuity [blurred vision · headache] - Sudden bleeding into the tumor (pituitary apoplexy) causes severe headache, vision changes, and loss of pituitary hormone function, and is a medical emergency [bleeding · headache] - In men, reduced sex drive, impotence, erectile dysfunction, and low sperm count from secondary hypogonadism can occur [erectile dysfunction] - In women, irregular or absent periods, infertility, reduced libido, and spontaneous milky nipple discharge can occur [absent periods · infertility · nipple discharge] - In children, the condition can cause growth arrest, delayed puberty, and periods that never start - Bone thinning, anxiety, depression, fatigue, and mood instability were noted in both sexes [anxiety · fatigue · low mood] - About 10% of these tumors also secrete growth hormone, producing gigantism or acromegaly SIGNS - what you find (2) - Cranial nerve palsy can occur, especially with an invasive tumor or sudden pituitary bleeding [bleeding · cranial nerve palsy] - Seizures, hydrocephalus, and swelling of one eye are described but are uncommon presentations [seizures] TESTS (1) - An eye specialist should formally chart the visual fields, especially when the tumor is a macroadenoma IF NOT THIS - what else fits (8) - Pregnancy, breastfeeding-related nipple stimulation, and stress are normal physiological causes of a raised prolactin level - Drugs that block dopamine - antipsychotics, tricyclics and SSRIs, antiemetics like metoclopramide or domperidone, verapamil or methyldopa, and opioids - can raise prolactin - An underactive thyroid gland or no identifiable cause (idiopathic) can explain a raised prolactin level - A non-prolactin-secreting pituitary adenoma can raise prolactin by pressing on the pituitary stalk - Hypothalamic disease, craniopharyngioma, meningioma, or dysgerminoma can also raise prolactin - Sarcoidosis, histiocytosis X, and prior cranial radiation are other recognized causes - Acromegaly, Cushing disease, empty sella syndrome, and lymphocytic hypophysitis are pituitary causes to rule out - Kidney failure and breast stimulation are also on the differential for a raised prolactin Source StatPearls "Prolactinoma" - disease-level clinical article Status traced to the source above 1. CABERGOLINE [1st line] Adult 0.5 mg weekly (administered as 0.25 mg twice weekly), titrate by 0.5 mg/week monthly up to max 4.5 mg/week based on prolactin levels - long-term Peds Specialist pediatric endocrinology management Source Endocrine Society Guideline on Pituitary Tumors 2011 Why Dopamine agonist that suppresses prolactin secretion by stimulating pituitary D2 receptors; first-line therapy for hyperprolactinaemia given its efficacy and tolerability advantage over bromocriptine, started only after pregnancy, hypothyroidism, and drug-induced causes have been excluded. Caution Cabergoline is the first-line dopamine agonist, with superior efficacy and tolerability over bromocriptine. Exclude pregnancy, hypothyroidism, and drug-induced causes (antipsychotics, metoclopramide) before starting. Perform baseline echocardiogram if high doses (>2 mg/week) or prolonged high-dose therapy are used due to risk of cardiac valvulopathy. Egypt CABERGOLACTO 0.5 MG 2 TABS. IDI > NOVELL ... 36.00 EGP (18.00/unit) CABERGLOBE 0.5 MG 2 TABS. EGPI > GLOBE ... 45.00 EGP (22.50/unit) MARVIGOLINE 0.5 MG 2 TABS. RAMEDA 66.00 EGP (33.00/unit) CABROSTINEX 0.5 MG 8 TABS. MEDIZEN PHARM... 339.00 EGP (42.38/unit) GOLINOTECH 0.5 MG 2 TABS. EUROPEAN EGYP... 103.00 EGP (51.50/unit) DOSTILACT 0.5 MG 2 TABS. ATCO PHARMA >... 105.00 EGP (52.50/unit) DOSTINEX 0.5 MG 2 TABS. PFIZER 172.00 EGP (86.00/unit) DELCABRIN 0.5 MG 2 SCORED TABS. EGPI > HEALTH... 105.00 EGP 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Hyperprolactinaemia (Evaluation & Management) - disease-level clinical article (hyperprolactinaemia-referral-full.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Pituitary apoplexy is an endocrine emergency presenting with sudden headache and visual disturbances, requiring urgent MRI and neurosurgical evaluation. 3. BROMOCRIPTINE [2nd line] Adult 1.25 mg at bedtime with food, titrate to 2.5 mg twice to three times daily - long-term Peds Specialist use only Source Egyptian National Drug Formulary - Endocrine System 2024 (bromocriptine monograph) Why Older dopamine agonist with the same prolactin-suppressing mechanism as cabergoline, preferred specifically when pregnancy is desired because of its longer safety track record in that setting. Caution Bromocriptine is the preferred dopamine agonist if pregnancy is desired, due to its extensive safety history. Nausea, postural hypotension, and dizziness are common during dose initiation. Egypt PARLODEL 2.5MG 20 TAB. NOVARTIS 27.60 EGP (1.38/unit) BROMOCRIPTINE 2.5 MG 30 TAB. OCTOBER PHARMA 66.00 EGP (2.20/unit) LACTODEL 2.5MG 20 TAB. AMOUN 72.00 EGP (3.60/unit) DOPAGON 2.5MG 20 TAB. MEMPHIS 94.00 EGP (4.70/unit) Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)