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Hyperprolactinemia

Last updated: March 11, 2021

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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.

Epidemiological data refers to the US, unless otherwise specified.

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

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

Hormonal changes Clinical features [7][8]
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 “Clinical features” in “Pituitary adenomas”)

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