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Hyperprolactinemia

Last updated: September 21, 2020

Summary

Hyperprolactinemia, which refers to the increased production of prolactin by the anterior pituitary, occurs physiologically during pregnancy, lactation, and periods of stress. Pathological hyperprolactinemia is most often the result of pituitary adenomas and less commonly due to primary hypothyroidism and/or dopamine antagonists (e.g., metoclopramide, haloperidol). Women with pathological hyperprolactinemia present with galactorrhea, loss of libido, infertility, menstrual dysfunction, and/or osteoporosis. Men generally present with loss of libido, erectile dysfunction, and/or gynecomastia. The diagnosis is confirmed by repeated measurement of early morning prolactin levels. After ruling out hypothyroidism, a cranial MRI should be performed to detect pituitary adenomas. Management consists of dopamine agonists (e.g., bromocriptine, cabergoline) and treating the underlying cause.

Epidemiology

References:[1][2]

Epidemiological data refers to the US, unless otherwise specified.

Etiology

Hypothalamic dopamine inhibits prolactin, whereas thyrotropin-releasing hormone (TRH) stimulates prolactin release!

Pituitary adenomas are the most common cause (∼ 50%) of pathological hyperprolactinemia!

References:[1][2][3][4]

Pathophysiology

References:[5][6]

Clinical features

Hormonal changes Clinical features
Female Male
Prolactin
LH + FSH
Testosterone
  • Loss of libido
Estrogen
  • Little to no noticeable effects

Patients with hyperprolactinemia due to a pituitary adenoma may also present with bitemporal hemianopsia and headache (see section on “Clinical features of pituitary adenomas”)

References:[1][7][8][9]

Diagnostics

References:[1][2][3]

Treatment

References:[1][2]

References

  1. Kasper DL, Fauci AS, Hauser SL, Longo DL, Lameson JL, Loscalzo J. Harrison's Principles of Internal Medicine. McGraw-Hill Education ; 2015
  2. Majumdar A, Mangal NS. Hyperprolactinemia. J Hum Reprod Sci. 2013; 6 (3): p.168-175. doi: 10.4103/0974-1208.121400 . | Open in Read by QxMD
  3. Ansstas G. Gynecomastia. In: Griffing GT, Gynecomastia. New York, NY: WebMD. http://emedicine.medscape.com/article/120858-overview#a5. Updated: June 14, 2016. Accessed: February 9, 2017.
  4. Johnson RE, Murad MH. Gynecomastia: pathophysiology, evaluation, and management. Mayo Clin Proc. 2009; 84 (11): p.1010-1015. doi: 10.1016/S0025-6196(11)60671-X . | Open in Read by QxMD
  5. Snyder PJ. Clinical manifestations and evaluation of hyperprolactinemia. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/clinical-manifestations-and-evaluation-of-hyperprolactinemia.Last updated: July 18, 2016. Accessed: February 9, 2017.
  6. Snyder PJ. Causes of hyperprolactinemia. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/causes-of-hyperprolactinemia?source=search_result&search=hyperprolactinemia&selectedTitle=1~150.Last updated: November 15, 2016. Accessed: February 9, 2017.
  7. Bahar A, Akha O, Kashi Z, Vesgari Z. Hyperprolactinemia in association with subclinical hypothyroidism. Caspian J Intern Med. . 2011; 2 (2): p.229–233.
  8. Goljan EF. Rapid Review Pathology. Elsevier Saunders ; 2013
  9. Gupta S. A Comprehensive Textbook of Obstetrics and Gynecology. JP Medical Ltd ; 2011
  10. Herold G. Internal Medicine. Herold G ; 2014