Do you initiate a dopamine agonist empirically in a patient with a pituitary microadenoma and a mildly elevated prolactin between 30 and 100 ng/mL, or do you pursue further workup to distinguish a true microprolactinoma from stalk effect before committing to treatment?

In a patient with a microadenoma, mild hyperprolactinemia (30-100 ng/mL) can be caused by tumorous secretion of prolactin, but stalk effect is also possible. In addition, co-secreting tumors (prolactin and either growth hormone or rarely ACTH) should be considered. I would first evaluate for hormone...

• If it is a microadenoma, the risk of this being stalk effect is minimal to none. If the patient needs prolactin normalization (is a male with hypogonadism or a non-post menopausal woman) treatment is needed. While dopaminergic therapy is the most used approach, the most recent Pituitary Society Cons...