Implications of not treating hyperprolactinemia.

When a patient with hyperprolactinemia is not treated, a number of ramifications can result, the most significant of which is osteoporosis. Evidence-based analysis shows that bone mineralization also can be affected by such problems as gonadal dysgenesis and possibly adrenal dysfunction. The hypoestrogenism associated with hyperprolactinemia is commonly assumed to be a potential cause of osteopenia in premenopausal women with this disorder, just as decreased estrogen is associated with bone loss following menopause. A number of studies also have shown that hyperprolactinemia decreases bone density independently of the hypoestrogenic state. In most, but not all, such women, bone density may be reestablished if one is successful in restoring normal menstrual function with dopamine agonists. With the availability of safe dopamine agonists like bromocriptine and now cabergoline, it seems prudent to attempt to normalize serum prolactin levels early on, before long-term pathologies set in.