Hyperprolactinaemia

ADULT

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Pituitary tumour with sudden severe headache
    • Acute onset visual loss or diplopia
    • Pituitary tumour with likely adrenal crisis (hypotension, tachycardia, vomiting, altered level of consciousness)
    • Refer to local HealthPathways or local guidelines
    • Withdraw any drugs likely to elevate serum prolactin if possible. Drug induced hyperprolactinaemia normalises within 4 days of cessation.
    • If patient is not clearly symptomatic, repeat serum prolactin and ask for macroprolactin (a variant of prolactin which is inactive) level
    • Pituitary MRI scan if serum prolactin after macroprolactin adjustment is > x 4 upper limit normal off relevant drugs in asymptomatic patients, or above upper limit normal in the presence of headache, neurological signs, pathological menstrual disturbance, galactorrhea or male androgen deficiency. In other cases, MRI may be performed if needed by the endocrine unit.
    • If pituitary mass detected then assess the rest of the anterior pituitary function with morning (08:00-09:00) cortisol, ACTH, TSH, T4, IGF1
Minimum Referral Criteria
Category 1
(appointment within 30 calendar days)
  • Pathological headaches with large (>10mm) pituitary mass
  • Serum prolactin >10x upper limit of normal range
Category 2
(appointment within 90 calendar days)
  • Serum prolactin 2-10x upper limit of normal range with galactorrhoea or oligo-amenorrhoea in women, hypogonadism in men
Category 3
(appointment within 365 calendar days)
  • Serum prolactin up to 2x upper limit of normal range without galactorrhoea or oligo-amenorrhoea in women, hypogonadism in men

Please insert the below information and minimum referral criteria into referral

1. Reason for request Indicate on the referral

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

2. Essential referral information Referral will be returned without this

  • Details of all treatments offered and efficacy
  • Symptoms and duration
  • Plans re pregnancy if relevant
  • Serum prolactin with repeat level and macroprolactin if no symptoms
  • TFT (TSH, free T4) creatinine and eGFR
  • 0800-0900 serum testosterone LH, FSH, SHBG in men
  • E2, LH and FSH in women
  • ßHCG in premenopausal women

3. Additional referral information Useful for processing the referral

  • Use of medications known to increase prolactin particularly:
    • Antipsychotics
    • Antiemetics
    • Opioids

4. Request

  • Patient's Demographic Details

    • Full name (including aliases)
    • Date of birth
    • Residential and postal address
    • Telephone contact number/s – home, mobile and alternative
    • Medicare number (where eligible)
    • Name of the parent or caregiver (if appropriate)
    • Preferred language and interpreter requirements
    • Identifies as Aboriginal and/or Torres Strait Islander

    Referring Practitioner Details

    • Full name
    • Full address
    • Contact details – telephone, fax, email
    • Provider number
    • Date of referral
    • Signature

    Relevant clinical information about the condition

    • Presenting symptoms (evolution and duration)
    • Physical findings
    • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
    • Body mass index (BMI)
    • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
    • Current medications and dosages
    • Drug allergies
    • Alcohol, tobacco and other drugs use

    Reason for request

    • To establish a diagnosis
    • For treatment or intervention
    • For advice and management
    • For specialist to take over management
    • Reassurance for GP/second opinion
    • For a specified test/investigation the GP can't order, or the patient can't afford or access
    • Reassurance for the patient/family
    • For other reason (e.g. rapidly accelerating disease progression)
    • Clinical judgement indicates a referral for specialist review is necessary

    Clinical modifiers

    • Impact on employment
    • Impact on education
    • Impact on home
    • Impact on activities of daily living
    • Impact on ability to care for others
    • Impact on personal frailty or safety
    • Identifies as Aboriginal and/or Torres Strait Islander

    Other relevant information

    • Willingness to have surgery (where surgery is a likely intervention)
    • Choice to be treated as a public or private patient
    • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service.  Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.

    • A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.

    • Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

Last updated: 2 December 2024

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