endo.hyperprolactinemia.core.v1PRODUCTION

endo.hyperprolactinemia.core.v1

Hyperprolactinaemia evaluation (exclude before prolactinoma)

endocrinologysubacutechronicadult

Hard-required inputs

0 / 7

Care setting:

Encounter flow

12/12 authored

Canonical 12-phase frame with authored status for this dossier.

Current phase

Frame

Detailed

Hyperprolactinaemia is a FINDING, not a diagnosis: this engine is the systematic Bayesian sieve (confirm → physiologic → drug → hypothyroid → renal/hepatic → macroprolactin → hook → stalk-vs-tumour → idiopathic) that ROUTES into endo.prolactinoma.core.v1 only after everything else is excluded (Endo Soc 2011 Melmed PMID 21296991)

Inputs

Actions

Advance rule

Set

Advance when

Raised PRL framed as a finding against the fixed exclusion ladder, not pre-labelled a prolactinoma

Patient inputs (14)

sex*demographic • CONTEXT

Presentation differs (women galactorrhoea/oligomenorrhoea early; men low libido/ED later) and changes the pre-test for symptomatic disease

pregnancy_status*demographic • CONTEXT

Pregnancy/lactation is the leading physiologic cause — exclude first in any reproductive-age woman

current_meds*medication • CONTEXT

not present

Drug-induced is the commonest non-physiologic cause; identify potent raisers (risperidone/paliperidone/metoclopramide) vs prolactin-sparing aripiprazole

serum_prolactin*lab • INITIAL_WORKUP

Core analyte; a single resting non-stressed value above the reference confirms — dynamic testing is NOT recommended (Endo Soc 2011)

beta_hcg*lab • INITIAL_WORKUP

Pregnancy — the single most common physiologic cause; halts the sieve when positive (Endo Soc 2011)

tsh_ft4*lab • INITIAL_WORKUP

Primary hypothyroidism raises TRH → PRL and can cause thyrotroph hyperplasia mimicking an adenoma — reversible secondary cause to exclude before imaging

creatinine_egfr*lab • INITIAL_WORKUP

CKD reduces PRL clearance (PRL ∝ creatinine r≈0.61) — true cause, not an assay artifact

macroprolactin_peglab • BRANCHING_WORKUP

PEG precipitation when high PRL but asymptomatic — macroprolactin (recovery <40%) is biologically inert; avoids unnecessary imaging/treatment

serum_prolactin_dilutedlab • BRANCHING_WORKUP

Hook-effect exclusion — 1:100 serial dilution whenever a large/giant sellar mass has only mildly elevated PRL

pituitary_mriimaging • BRANCHING_WORKUP

not present

Dedicated sellar MRI ONLY after physiologic/drug/hypothyroid/renal-hepatic/macroprolactin excluded — defines stalk-effect mass vs true prolactinoma

chest_wall_or_renal_hepatic_historyhistory • CONTEXT

not present

Chest-wall lesions / herpes zoster / thoracotomy (neurogenic) and CKD/cirrhosis (clearance) are systemic causes to capture in context

psychiatric_diagnosishistory • CONTEXT

not present

A psychiatric diagnosis on a potent antipsychotic mandates shared decision-making — the antipsychotic is NOT stopped unilaterally

serum_prolactin_repeat_restinglab • INITIAL_WORKUP

Repeat without venepuncture stress when borderline — reclassifies stress artifact to normal before any workup (Endo Soc 2011)

lftlab • INITIAL_WORKUP

Cirrhosis is a systemic cause of mild hyperprolactinaemia

* = hard-required. Engine cannot meaningfully run until these are filled.

Severity triggers (12)

12 need judgement

informationallife_threateningmacroadenoma_visual_compromise_route_out
Macroadenoma with progressive bitemporal visual field loss or acute apoplectic headache + ophthalmoplegia (Pituitary Soc 2023 Petersenn)
Trigger could not be auto-evaluated — needs clinician judgement.
informationalseveregiant_mass_mild_prl_hook_effect
Large/giant sellar mass with only mildly elevated prolactin — HOOK EFFECT until a 1:100 serial dilution proves otherwise (Pituitary Soc 2023 Petersenn; Barkan)
Trigger could not be auto-evaluated — needs clinician judgement.
informationalmoderateantipsychotic_induced_hyperprolactinemia
Symptomatic hyperprolactinaemia on a potent antipsychotic (risperidone / paliperidone / amisulpride) in a patient with a psychiatric diagnosis (Endo Soc 2011 Melmed)
Trigger could not be auto-evaluated — needs clinician judgement.
informationalmoderatetrue_symptomatic_prolactinoma_route_out
Confirmed true hyperprolactinaemia + concordant sellar lesion after ALL secondary causes excluded (PRL >250 + macroadenoma strongly favours true macroprolactinoma) (Pituitary Soc 2023 Petersenn)
Trigger could not be auto-evaluated — needs clinician judgement.
informationalmoderateprl_magnitude_lr_conditional_on_assay_and_macroprolactin
CONDITIONAL DEPENDENCE — the PRL-magnitude likelihood ratio is NOT interpretable until assay state (hook) and macroprolactin are resolved: a hook-saturated assay can read 11.3 µg/L in a giant adenoma (→ 5795 on 1:100 dilution), and macroprolactin can keep total PRL high while symptomatic-prolactinoma probability is low (Petakov; St-Jean; Kalsi)
Trigger could not be auto-evaluated — needs clinician judgement.
informationalmoderatedrug_induced_lr_conditional_on_antipsychotic_class
CONDITIONAL DEPENDENCE — the drug-induced LR depends on the antipsychotic CLASS: a 25–100 ng/mL value on risperidone/paliperidone/amisulpride is explained by the drug and does NOT independently raise the tumour posterior; the SAME value on prolactin-sparing aripiprazole argues AGAINST drug as the cause (Ma; Koller; Chen)
Trigger could not be auto-evaluated — needs clinician judgement.
informationalmoderatestalk_vs_adenoma_joint_mri_and_magnitude
CONDITIONAL DEPENDENCE — stalk-effect vs true prolactinoma is a JOINT call on MRI + PRL magnitude, not either alone: a large mass with only mild PRL (border-zone 90–200 ng/mL false-positive 18.9%) is stalk effect until a DA trial shrinks the mass (Kawaguchi; Wright; Leca)
Trigger could not be auto-evaluated — needs clinician judgement.
informationalmildpregnancy_or_lactation_physiologic
Reproductive-age woman with raised PRL and possible pregnancy / lactation / nipple stimulation (Endo Soc 2011 Melmed)
Trigger could not be auto-evaluated — needs clinician judgement.
informationalmildmacroprolactinemia_do_not_treat
Asymptomatic / discordant high PRL with PEG recovery <40% — biologically inert macroprolactinaemia (Endo Soc 2011 Melmed; Kalsi)
Trigger could not be auto-evaluated — needs clinician judgement.
informationalmildckd_or_cirrhosis_clearance_cause
Mild–moderate hyperprolactinaemia attributable to reduced clearance in CKD (reduced eGFR / dialysis) or cirrhosis (Yavuz)
Trigger could not be auto-evaluated — needs clinician judgement.
informationalmildpcos_oligomenorrhoea_overlap_route
Oligo/amenorrhoeic woman where PCOS and hyperprolactinaemia overlap — 11.4–11.6% of PCOS cohorts are hyperprolactinaemic and the prolactinoma PRL cut-point is LOWER in this population (52.9–85.2 ng/mL) (Kim; Kyritsi)
Trigger could not be auto-evaluated — needs clinician judgement.
informationalmildthyrotoxicosis_with_raised_prl_route
Thyrotoxicosis (Graves or a TSH-secreting pituitary tumour) presenting with galactorrhoea + raised PRL — the raised PRL reverses with treatment of the thyroid lesion (Kamoi)
Trigger could not be auto-evaluated — needs clinician judgement.

Workflow calculators

This dossier does not reference any calculators.

Recommended regimen

Hyperprolactinaemia cause-directed ladder — confirm → physiologic → drug deprescribe/swap → treat hypothyroidism → macroprolactin PEG (reassure) → hook-effect dilution → ROUTE true prolactinoma (Endo Soc 2011 Melmed; Pituitary Soc 2023 Petersenn)

axis: hyperprolactinemia_cause_directed_exclusion_ladderstep 1 - Step 1 — Confirm true elevation & exclude physiologic (no drug)

Selected step "Step 1 — Confirm true elevation & exclude physiologic (no drug)" — Any elevated serum prolactin before labelling a cause

repeat resting non-stressed serum prolactin
first line
preanalytic_confirmation
triggers: borderline_or_mild_elevation, venepuncture_stress_possible
Endo Soc 2011 (PMID 21296991) — a single resting non-stressed value above the reference confirms; dynamic testing is NOT recommended; repeat reclassifies stress artifact to normal
β-hCG / pregnancy & lactation screen
first line
physiologic_exclusion
triggers: reproductive_age_woman, amenorrhoea
Endo Soc 2011 (PMID 21296991) — pregnancy/lactation is the leading physiologic cause; a positive β-hCG halts the sieve

outpatient playbook — drug actions (5)

1. repeat resting PRL + β-hCG (confirm / exclude physiologic)
no drug • n/a • once
trigger: Any elevated PRL
Confirm true non-stressed elevation and exclude pregnancy/lactation before workup (Endo Soc 2011 Melmed)
2. deprescribe/swap offending drug; aripiprazole adjunct/switch WITH psychiatry
aripiprazole 5–10 mg PO daily (psychiatry-led) • PO • once daily
trigger: Drug-induced (esp. potent antipsychotic)
Prolactin-sparing aripiprazole normalised PRL in 46%, NNT 2 (Raghuthaman PMID 27703744); never stop antipsychotic unilaterally (Endo Soc 2011 Melmed)
3. levothyroxine for primary hypothyroidism
≈1.6 µg/kg/day, titrate to TSH • PO • once daily
trigger: High TSH + low/normal FT4 with raised PRL
Reverses TRH-driven PRL + thyrotroph hyperplasia (Fernández-Real PMID 9534344); route to endo.hypothyroidism.core.v1
4. PEG macroprolactin → reassure (no drug)
n/a • n/a • once
trigger: Asymptomatic / discordant high PRL
Recovery <40% = inert macroprolactin — reassure, no imaging/DA (Kalsi PMID 30269265)
5. route true symptomatic prolactinoma to endo.prolactinoma.core.v1 (no DA here)
n/a • n/a • once
trigger: True hyperprolactinaemia + concordant lesion, secondary causes excluded
DA ladder owned by the prolactinoma engine (Pituitary Soc 2023 Petersenn PMID 37670148)

Auto-drafted A&P note

outpatient

Subjective

- Possible entry pathways: Incidental / screening elevated serum prolactin — finding, not diagnosis (Endo Soc 2011 Melmed); Woman: galactorrhoea ± oligo/amenorrhoea ± infertility (Endo Soc 2011 Melmed); Man: low libido / erectile dysfunction / gynaecomastia / infertility (Pituitary Soc 2023 Petersenn).

Objective

- No vitals, labs, or imaging entered for this encounter.

Assessment

**Hyperprolactinaemia evaluation (exclude before prolactinoma)** (endo.hyperprolactinemia.core.v1).
Phenotype framing: MECE terminal split with the named pivot + discriminating LR per pair: physiologic (β-hCG) vs drug-induced (med review/washout; aripiprazole-sparing vs risperidone-raising) vs primary hypothyroidism (TSH/FT4, reversible — route endo.hypothyroidism.core.v1) vs hyperthyroidism/TSH-secreting tumour (thyrotoxicosis + galactorrhoea, raised PRL reverses with the thyroid lesion — Kamoi PMID 3934894 → endo.hyperthyroidism.core.v1) vs PCOS-with-hyperprolactinaemia (oligomenorrhoea overlap; 11.4–11.6% of PCOS hyperprolactinaemic, PRL band lower 52.9–85.2 ng/mL — Kim PMID 37057215, Kyritsi PMID 29845629 → endo.pcos.core.v1) vs CKD/cirrhosis (creatinine∝PRL r=0.609) vs macroprolactinaemia (PEG recovery <40%) vs hook effect (1:100 dilution; 5.8–14.2% of macroadenomas) vs stalk effect (MRI + DA trial: PRL falls but mass does NOT shrink — Kawaguchi border-zone false-positive 18.9% PMID 25142896) vs true prolactinoma (PRL ≥85.2 ng/mL LR+ ≈28 / PRL 62.45 LR+ 16.6; >250 + macroadenoma; PRL falls AND mass shrinks) vs idiopathic (exclusion + surveillance) (Endo Soc 2011 Melmed; Pituitary Soc 2023 Petersenn)
Scope: Hyperprolactinaemia is a FINDING, not a diagnosis: this engine is the systematic Bayesian sieve (confirm → physiologic → drug → hypothyroid → renal/hepatic → macroprolactin → hook → stalk-vs-tumour → idiopathic) that ROUTES into endo.prolactinoma.core.v1 only after everything else is excluded (Endo Soc 2011 Melmed PMID 21296991)

No severity triggers fired against current inputs.

Plan

Regimen axis: **Hyperprolactinaemia cause-directed ladder — confirm → physiologic → drug deprescribe/swap → treat hypothyroidism → macroprolactin PEG (reassure) → hook-effect dilution → ROUTE true prolactinoma (Endo Soc 2011 Melmed; Pituitary Soc 2023 Petersenn)** — step "Step 1 — Confirm true elevation & exclude physiologic (no drug)".
1. repeat resting non-stressed serum prolactin (preanalytic_confirmation, first line) — Endo Soc 2011 (PMID 21296991) — a single resting non-stressed value above the reference confirms; dynamic testing is NOT recommended; repeat reclassifies stress artifact to normal
2. β-hCG / pregnancy & lactation screen (physiologic_exclusion, first line) — Endo Soc 2011 (PMID 21296991) — pregnancy/lactation is the leading physiologic cause; a positive β-hCG halts the sieve

Setting playbook (outpatient) — Run the Bayesian exclusion sieve, treat/reassure the reversible cause, and route a true symptomatic prolactinoma to endo.prolactinoma.core.v1 — avoiding over-imaging and over-treatment of artifact/drug/physiologic causes (Endo Soc 2011 Melmed; Pituitary Soc 2023 Petersenn)
3. repeat resting PRL + β-hCG (confirm / exclude physiologic) no drug n/a once — Any elevated PRL (Confirm true non-stressed elevation and exclude pregnancy/lactation before workup (Endo Soc 2011 Melmed))
4. deprescribe/swap offending drug; aripiprazole adjunct/switch WITH psychiatry aripiprazole 5–10 mg PO daily (psychiatry-led) PO once daily — Drug-induced (esp. potent antipsychotic) (Prolactin-sparing aripiprazole normalised PRL in 46%, NNT 2 (Raghuthaman PMID 27703744); never stop antipsychotic unilaterally (Endo Soc 2011 Melmed))
5. levothyroxine for primary hypothyroidism ≈1.6 µg/kg/day, titrate to TSH PO once daily — High TSH + low/normal FT4 with raised PRL (Reverses TRH-driven PRL + thyrotroph hyperplasia (Fernández-Real PMID 9534344); route to endo.hypothyroidism.core.v1)
6. PEG macroprolactin → reassure (no drug) n/a n/a once — Asymptomatic / discordant high PRL (Recovery <40% = inert macroprolactin — reassure, no imaging/DA (Kalsi PMID 30269265))
7. route true symptomatic prolactinoma to endo.prolactinoma.core.v1 (no DA here) n/a n/a once — True hyperprolactinaemia + concordant lesion, secondary causes excluded (DA ladder owned by the prolactinoma engine (Pituitary Soc 2023 Petersenn PMID 37670148))

Non-pharmacologic actions:
- Repeat resting non-stressed PRL; β-hCG; dynamic testing NOT recommended (Endo Soc 2011 Melmed)
- Macroprolactin PEG precipitation → reassure if inert (Kalsi PMID 30269265)
- 1:100 serial dilution for giant mass with mild PRL (Barkan PMID 9574657)
- Pituitary MRI only after secondary/physiologic/drug exclusion (Endo Soc 2011 Melmed)
- Psychiatry co-management for antipsychotic-induced disease; route prolactinoma/hypopituitarism/hypothyroidism by engine_id (Pituitary Soc 2023 Petersenn)

AVOID / contraindication checks:
- Do NOT stop an antipsychotic unilaterally — manage antipsychotic induced hyperprolactinaemia WITH psychiatry (Endo Soc 2011 Melmed PMID 21296991)
- Do NOT treat or image confirmed macroprolactinaemia — biologically inert; reassure (Endo Soc 2011 PMID 21296991; Kalsi PMID 30269265)
- Always 1:100 serial dilution before surgery for a giant sellar mass with only mildly raised PRL (HOOK EFFECT — Barkan PMID 9574657; Pituitary Soc 2023 PMID 37670148)
- Do NOT order pituitary MRI for asymptomatic drug induced or physiologic elevation — image only confirmed PERSISTENT non physiologic non drug elevation (Endo Soc 2011 PMID 21296991)
- Dynamic prolactin testing is NOT recommended — a single resting non stressed value confirms (Endo Soc 2011 PMID 21296991)
- This engine does NOT initiate a dopamine agonist — route true symptomatic prolactinoma to endo.prolactinoma.core.v1 (Pituitary Soc 2023 PMID 37670148)

Monitoring

Regimen monitoring:
- recheck serum PRL after drug washout / after levothyroxine to euthyroid / after lactation ends BEFORE any imaging (Endo Soc 2011 Melmed PMID 21296991)
- macroprolactinaemia: no treatment and NO follow-up imaging (Kalsi PMID 30269265)
- idiopathic: periodic PRL ± symptom review — most stable/resolve, ~34% normalise, ~1/41 develop a tumour (Martin PMID 3980670)
- antipsychotic-induced: PRL + symptom co-monitoring with psychiatry after aripiprazole adjunct/switch (Raghuthaman PMID 27703744)
- true prolactinoma routed out: monitoring owned by endo.prolactinoma.core.v1 (Pituitary Soc 2023 PMID 37670148)

Setting (outpatient) monitoring:
- Recheck PRL after washout / euthyroid / lactation ends before imaging (Endo Soc 2011 Melmed)
- Macroprolactinaemia: no treatment, no follow-up imaging (Kalsi PMID 30269265)
- Idiopathic: periodic PRL ± symptoms (Martin PMID 3980670)
- Drug-induced: PRL + symptoms co-monitored with psychiatry after aripiprazole (Raghuthaman PMID 27703744)

Follow-up plan: Idiopathic hyperprolactinaemia surveillance (most stable/resolve — Martin PMID 3980670); preconception counselling (prolactinoma pregnancy risk owned by endo.prolactinoma.core.v1 — micro ~1% vs macro 23% growth if DA stopped, Molitch PMID 10649822); reinforce that the antipsychotic is managed with psychiatry; return precautions (visual change, severe headache, new galactorrhoea) (Endo Soc 2011 Melmed; Pituitary Soc 2023 Petersenn)
- Close-out criterion: Long-term surveillance / preconception / psychiatry-shared plan booked

Monitoring phase: After a reversible cause is removed, RECHECK serum PRL (drug washout / after levothyroxine to target / after delivery-lactation ends) before any imaging — re-imaging is only for persistent unexplained elevation. Macroprolactin: no follow-up imaging needed. Idiopathic: periodic PRL ± symptom review (34% normalise; 1/41 develop a tumour — Martin PMID 3980670) (Endo Soc 2011 Melmed PMID 21296991)

Disposition

Current setting: outpatient — Run the Bayesian exclusion sieve, treat/reassure the reversible cause, and route a true symptomatic prolactinoma to endo.prolactinoma.core.v1 — avoiding over-imaging and over-treatment of artifact/drug/physiologic causes (Endo Soc 2011 Melmed; Pituitary Soc 2023 Petersenn)

Disposition criteria:
- Continue outpatient endocrinology if cause reversible/benign and PRL normalising (Endo Soc 2011 Melmed)
- Route by engine_id: true prolactinoma → endo.prolactinoma.core.v1; stalk/mass → endo.hypopituitarism.core.v1; hypothyroid cause → endo.hypothyroidism.core.v1 (Pituitary Soc 2023 Petersenn)

Escalation triggers (move to higher acuity):
- Giant sellar mass with only mildly raised PRL → 1:100 dilution NOW before any surgical decision (hook effect — Barkan PMID 9574657)
- Macroadenoma + acute headache + visual field loss / ophthalmoplegia → ED + route to pituitary engines (apoplexy — Pituitary Soc 2023 Petersenn)
- True symptomatic prolactinoma confirmed → route to endo.prolactinoma.core.v1 for DA (Pituitary Soc 2023 Petersenn)
- Severe psychiatric destabilisation if antipsychotic altered → psychiatry urgent (Endo Soc 2011 Melmed)

Patient Action Plan

**Raised prolactin — what it means and what to watch for**
Personalised values: suspected_cause, offending_drug, prl_level, pregnancy_plan.

**Cause found and addressed (drug, thyroid, macroprolactin, physiologic)** (green):
Triggers:
- A clear reversible cause was identified (a medicine, thyroid, pregnancy, or a harmless lab variant)
- Prolactin is improving after the cause was treated or the medicine changed
- No headaches or vision changes
Actions:
- Keep the follow-up prolactin blood test your provider arranged (Endo Soc 2011 Melmed)
- If your raised prolactin is a harmless lab variant (macroprolactin), no treatment or scans are needed — reassurance only (Kalsi PMID 30269265)
- Do NOT stop a psychiatric medicine on your own — any change is made together with your psychiatrist (Endo Soc 2011 Melmed)
- If you take thyroid medicine for an underactive thyroid, take it consistently and keep thyroid checks

**Symptoms or an unexplained result that needs more workup** (yellow):
Triggers:
- Milky breast discharge, irregular/absent periods, low sex drive, or fertility concerns
- Prolactin stays high after the likely cause was addressed
- You are planning a pregnancy
Actions:
- Attend the further tests your provider orders (repeat prolactin, thyroid, kidney, possibly a pituitary MRI) (Endo Soc 2011 Melmed)
- Bring an up-to-date list of ALL your medicines including psychiatric medicines (Endo Soc 2011 Melmed)
- Tell your provider if you are planning a pregnancy so the right pathway is followed (Molitch PMID 10649822)
Contact provider when:
- New or worsening milky discharge, period changes, or fertility problems (Endo Soc 2011 Melmed)
- Prolactin remains high despite addressing the suspected cause (Endo Soc 2011 Melmed)

**Possible pituitary mass pressing on nearby structures** (red):
Triggers:
- Sudden severe headache
- New loss of side (peripheral) vision or double vision
- Sudden severe headache with vomiting and visual loss (possible pituitary apoplexy)
Actions:
- Go to the emergency department or call emergency services now
- This can mean a pituitary mass affecting the nerves to the eyes — it needs urgent imaging and specialist care (Pituitary Soc 2023 Petersenn)
- Bring your medication list
Contact provider when:
- Always seek emergency care for sudden severe headache with vision loss (Pituitary Soc 2023 Petersenn)

Earlier-Return Triggers

Return-precaution thresholds (watch for):
- [LIFE_THREATENING] Macroadenoma with progressive bitemporal visual field loss or acute apoplectic headache + ophthalmoplegia (Pituitary Soc 2023 Petersenn)
- [SEVERE] Large/giant sellar mass with only mildly elevated prolactin — HOOK EFFECT until a 1:100 serial dilution proves otherwise (Pituitary Soc 2023 Petersenn; Barkan)
- [MODERATE] Symptomatic hyperprolactinaemia on a potent antipsychotic (risperidone / paliperidone / amisulpride) in a patient with a psychiatric diagnosis (Endo Soc 2011 Melmed)

Citations

- Endocrine Society 2011 Hyperprolactinaemia Clinical Practice Guideline (Melmed, JCEM 2011;96:273-88, PMID 21296991) + Pituitary Society 2023 international Consensus on prolactinomas (Petersenn, Nat Rev Endocrinol 2023;19:722-740, PMID 37670148); reconciled with cohort/RCT/ROC literature for the Bayesian sieve (PRL-magnitude LRs wired from Wright PMID 33966173, Leca PMID 33963239, Kyritsi PMID 29845629, Kim PMID 37057215, Kawaguchi PMID 25142896; hook effect Petakov PMID 9591215 / St-Jean PMID 8729527) [PMID:21296991](https://pubmed.ncbi.nlm.nih.gov/21296991/)
- Cited evidence (PMID 37670148) [PMID:37670148](https://pubmed.ncbi.nlm.nih.gov/37670148/)
- Cited evidence (PMID 30269265) [PMID:30269265](https://pubmed.ncbi.nlm.nih.gov/30269265/)
- Cited evidence (PMID 32597541) [PMID:32597541](https://pubmed.ncbi.nlm.nih.gov/32597541/)
- Cited evidence (PMID 9574657) [PMID:9574657](https://pubmed.ncbi.nlm.nih.gov/9574657/)

Last reconciled with current guidelines: 2026-05-22.

References

Endocrine Society 2011 Hyperprolactinaemia Clinical Practice Guideline (Melmed, JCEM 2011;96:273-88, PMID 21296991) + Pituitary Society 2023 international Consensus on prolactinomas (Petersenn, Nat Rev Endocrinol 2023;19:722-740, PMID 37670148); reconciled with cohort/RCT/ROC literature for the Bayesian sieve (PRL-magnitude LRs wired from Wright PMID 33966173, Leca PMID 33963239, Kyritsi PMID 29845629, Kim PMID 37057215, Kawaguchi PMID 25142896; hook effect Petakov PMID 9591215 / St-Jean PMID 8729527) — PMID:21296991
Cited evidence (PMID 37670148) — PMID:37670148
Cited evidence (PMID 30269265) — PMID:30269265
Cited evidence (PMID 32597541) — PMID:32597541
Cited evidence (PMID 9574657) — PMID:9574657