Description
High prolactin levels (hyperprolactinemia) occur when the pituitary gland produces excessive prolactin, a hormone primarily responsible for lactation and reproductive functions. Elevated prolactin can affect both men and women and is often associated with reproductive and hormonal disruptions. Causes of Hyperprolactinemia Physiological Causes: Pregnancy Breastfeeding Stress (physical or psychological) Exercise Pathological Causes: Prolactinomas (Pituitary Tumors): Benign tumors in the pituitary gland secreting prolactin. Hypothyroidism: Elevated thyrotropin-releasing hormone (TRH) can stimulate prolactin secretion. Kidney or Liver Disease: Impaired clearance of prolactin. Polycystic Ovary Syndrome (PCOS): Hormonal imbalance contributing to mildly elevated prolactin. Chest Wall Injuries or Irritation: Due to trauma, surgery, or shingles. Medication-Induced: Antipsychotics (e.g., risperidone, haloperidol) Antidepressants (e.g., SSRIs, TCAs) Anti-nausea drugs (e.g., metoclopramide) Oral contraceptives (rare) Idiopathic Causes: Elevated prolactin with no identifiable cause. Symptoms of Hyperprolactinemia In Women: Irregular or absent menstrual periods (amenorrhea) Infertility Breast milk production unrelated to pregnancy or nursing (galactorrhea) Decreased libido Vaginal dryness In Men: Decreased libido Erectile dysfunction Infertility Gynecomastia (rare) Headaches and visual disturbances (if due to a pituitary tumor) General Symptoms: Headache or vision changes (with large pituitary tumors) Bone loss (due to low estrogen or testosterone) Diagnosis Laboratory Tests: Serum Prolactin Levels: Normal range: ≤25 ng/mL (varies slightly by lab). Mild elevation (<50 ng/mL) may indicate stress, PCOS, or medication effects. Moderate to high levels (>100 ng/mL) suggest prolactinoma or hypothyroidism. Thyroid Function Tests: To rule out hypothyroidism. Renal and Liver Function Tests: To check for systemic causes. Imaging: MRI of the Pituitary Gland: To identify prolactinomas or other pituitary abnormalities. Medication Review: Assess for drugs that could elevate prolactin. Treatment The approach depends on the cause and severity of hyperprolactinemia. 1. Observation: For mild, asymptomatic elevations not requiring treatment. Periodic monitoring of prolactin levels. 2. Medical Treatment: Dopamine Agonists: First-line therapy for prolactinomas and idiopathic hyperprolactinemia. Examples: Cabergoline: Preferred due to fewer side effects and weekly dosing. Bromocriptine: Effective but may cause nausea and fatigue. Thyroid Hormone Replacement: For hypothyroidism-induced hyperprolactinemia. Medication Adjustments: Replace or discontinue drugs contributing to elevated prolactin, if possible. 3. Surgical Treatment: Transsphenoidal Surgery: For prolactinomas that are resistant to medical treatment or causing significant compression (e.g., vision loss). 4. Radiation Therapy: Rarely used, reserved for aggressive or recurrent tumors. Complications of Untreated Hyperprolactinemia Infertility Osteoporosis (due to low estrogen/testosterone) Persistent vision problems (in cases of large prolactinomas) Hypopituitarism (with large tumors compressing surrounding pituitary tissue) Monitoring and Follow-up Prolactin Levels: Regular testing to assess treatment response. MRI Scans: To monitor tumor size, especially with macroprolactinomas. Bone Density Testing: For patients at risk of osteoporosis. Key Takeaway: Hyperprolactinemia is often treatable, especially when identified early. Dopamine agonists are highly effective for prolactinomas, and addressing underlying causes (e.g., hypothyroidism or medication effects) can normalize prolactin levels. Regular follow-up is critical to prevent complications.
