Hyperprolactinemia / Prolactinomas in the post-menopausal period: <br><br>challenges in diagnosis and management <br><br>.

<br>Hyperprolactinemia is not a common finding in post-menopausal women. Prolactinomas detected after menopause are usually macroadenomas. Due to atypical clinical features they may remain un-recognized for a long period of time. Interestingly the growth potential of prolactinomas remains after menopause. Most tumors are invasive and present with high prolactin levels. They respond to medical treatment with dopamine agonists both in terms of prolactin normalization, tumor shrinkage and improvement in pituitary function. Treatment with dopamine agonists is usually long-term. Reducing doses of cabergoline to the lowest that keeps prolactin normal prior to withdrawal is proposed to patients with macroprolactinomas who normalize prolactin after > 5 years of treatment and who do not have cavernous sinus invasion. Cabergoline can achieve a high percentage of remission maintenance in the first years after withdrawal. However the percentage of relapse free patients 5 years after withdrawal is significantly lower. Besides recurrent hyperprolactinemia in a subgroup of macroprolactinomas after a long interval tumor regrowth may be detected. Menopause cannot ensure remission of the tumor so long term surveillance is suggested. In patients with microadenomas data on long-term remission rate (normalization of prolactin and disappearance of the tumor) after suspension of treatment with dopamine agonist are higly variable. Current strategy for microprolactinomas is not to treat hyperprolactinemia in menopause if it recurrs after discontinuation of dopamine agonists. This is based on: 1) reports that elevated prolactin levels may normalize in some women after menopause, 2) the association between prolactin levels and breast cancer is inconsistent in postmenopausal women, 3) there is no clinical evidence that normalization of prolactin levels in postmenopausal women improved bone mineral density (BMD) or reduced fracture risk and, 4) concerning the metabolic syndrome no data are available on metabolic parameters after suspending treatment with dopamine agonists. For a change in strategy i.e. for the potential benefits from treatment of hyperprolactinemia in the postmenopausal period with dopamine agonists concerning weight loss, improved insulin sensitivity, decreased fracture risk, improved sexuality more evidence is needed.<br>.