Find comprehensive information on Prolactin Disorders, including hyperprolactinemia, galactorrhea, amenorrhea, infertility, and pituitary adenoma. Learn about diagnosis codes (ICD-10 E22.1, SNOMED CT), clinical documentation requirements, laboratory testing for prolactin levels, differential diagnosis considerations, and treatment options. This resource provides valuable insights for healthcare professionals, medical coders, and patients seeking information on Prolactin Disorders management and documentation best practices.
Also known as
Hyperprolactinemia
Elevated prolactin levels in the blood.
Prolactin deficiency
Insufficient prolactin production.
Pituitary adenoma
Benign tumor of the pituitary gland, often causing prolactin disorders.
Ovulatory disorders
Problems with ovulation, sometimes related to prolactin imbalances.
Follow this step-by-step guide to choose the correct ICD-10 code.
Is the prolactin level elevated?
Yes
Is it due to a medication?
No
Is prolactin abnormally low?
When to use each related code
| Description |
|---|
| High prolactin levels |
| Prolactinoma |
| Drug-induced hyperprolactinemia |
Using unspecified codes like E22.9 when a more specific prolactin disorder diagnosis is documented leads to inaccurate reporting and lost revenue.
Failing to code drug-induced hyperprolactinemia (E22.1) when documented may lead to inaccurate quality metrics and incorrect treatment plans.
Incorrectly coding prolactinomas (D35.2) with pituitary adenomas (D35.1) can result in inappropriate treatment and skewed clinical data analysis.
Q: What are the most effective diagnostic tests for differentiating between physiological hyperprolactinemia and a true prolactin-secreting pituitary adenoma?
A: Differentiating physiological hyperprolactinemia from a prolactin-secreting pituitary adenoma requires a careful evaluation involving several diagnostic tests. Begin with a thorough medical history, including medication review, as certain drugs can elevate prolactin levels. Initial testing involves measuring fasting serum prolactin levels. Mildly elevated prolactin (e.g., <100 ng/mL) may be due to physiological causes like stress, nipple stimulation, or medications. If significantly elevated, further investigations are warranted. Dynamic testing, such as a TRH stimulation test, may help distinguish stalk effect from a true adenoma, as prolactin levels generally remain unchanged or decrease in adenoma cases. MRI of the pituitary gland with dynamic contrast enhancement is crucial for visualizing the pituitary gland and identifying the presence of an adenoma. Consider implementing a protocol that includes a high-resolution MRI tailored to the pituitary region to better detect microadenomas. Explore how incorporating these tests into your practice can improve the accuracy of prolactin disorder diagnosis and management. Learn more about the latest guidelines for interpreting pituitary MRI findings.
Q: How do I manage a patient with hyperprolactinemia who is experiencing treatment resistance to dopamine agonists like cabergoline?
A: Treatment resistance to dopamine agonists in hyperprolactinemia can be challenging, but several strategies can be considered. First, confirm adherence to the prescribed medication and rule out other causes of elevated prolactin, such as drug interactions or macroprolactinemia (the presence of large, biologically inactive prolactin molecules). If adherence is confirmed and other causes are excluded, consider increasing the dopamine agonist dose gradually, under careful monitoring for side effects. For patients genuinely refractory to cabergoline, alternative dopamine agonists like bromocriptine can be tried, though they are often less effective and associated with more side effects. In rare cases, transsphenoidal surgery might be considered, particularly for patients with large adenomas causing mass effects or experiencing persistent symptoms despite optimal medical therapy. Explore how multidisciplinary collaboration with an endocrinologist and neurosurgeon can enhance management strategies for complex cases of hyperprolactinemia. Consider implementing a patient-specific approach that takes into account their individual circumstances and preferences when choosing a treatment path. Learn more about the long-term implications of persistent hyperprolactinemia and strategies for mitigating these risks.
Patient presents with concerns regarding symptoms suggestive of a prolactin disorder. Chief complaint includes [insert chief complaint e.g., galactorrhea, menstrual irregularities, infertility, decreased libido, erectile dysfunction, headaches]. Patient reports [detailed history of present illness including symptom onset, duration, frequency, and character]. Past medical history includes [list relevant medical history e.g., pituitary adenoma, hypothyroidism, polycystic ovary syndrome, renal disease, medications known to elevate prolactin]. Family history is significant for [list relevant family history e.g., pituitary disorders, endocrine conditions]. Medications include [list current medications including dosages and frequencies]. Physical examination reveals [document relevant findings e.g., presence of galactorrhea, visual field defects, gynecomastia, testicular atrophy]. Differential diagnosis includes hyperprolactinemia, prolactinoma, drug-induced hyperprolactinemia, hypothyroidism, and other pituitary disorders. Initial laboratory testing includes serum prolactin levels, thyroid function tests (TSH, free T4), and potentially imaging studies such as MRI of the pituitary gland to evaluate for the presence of a prolactinoma. Assessment points toward [working diagnosis e.g., hyperprolactinemia likely secondary to [cause e.g., medication, prolactinoma, idiopathic]]. Plan includes [outline treatment plan e.g., medication management with dopamine agonists such as cabergoline or bromocriptine, surgical intervention if indicated, referral to endocrinology, patient education regarding prolactin disorders, follow-up prolactin levels and clinical assessment to monitor treatment response]. Patient was counseled on the risks and benefits of the proposed treatment plan and provided educational materials on prolactin disorders, their management, and potential complications. Follow-up appointment scheduled for [date and time] to reassess symptoms, review lab results, and adjust treatment as needed. ICD-10 code [appropriate ICD-10 code e.g., E22.1, D44.1] assigned.