Raised prolactin levels

Dr Umasuthan Srirangalingam, consultant endocrinologist at London Lauriston Clinic in London, explains causes, diagnosis and treatment of raised prolactin levels.

What is prolactin?

Prolactin is a hormone produced by the pituitary gland, a small structure at the base of the brain. Prolactin plays an important role in reproduction and in stimulating milk production after childbirth. Prolactin is present in both women and men but causes different signs and symptoms when raised.

What happens when prolactin levels are higher than normal?

When prolactin levels are higher than normal, a condition called hyperprolactinaemia occurs. This is a relatively common finding, but there are many possible causes, so it’s important to identify the reason accurately.

As an endocrinologist in London, I frequently see patients who have been told their prolactin is raised. Most causes are entirely benign, but understanding the reason behind this is essential for avoiding unnecessary worry, and ensures the right treatment.

What causes raised prolactin levels?

There are a number of factors that can temporarily or falsely raise prolactin levels. Recognising these is vital before making a diagnosis.

Common causes include:

Pregnancy and breastfeeding: These are natural and expected causes of raised prolactin, as the hormone supports milk production.
Stress or recent illness: Physical or emotional stress can temporarily elevate prolactin levels.
Medications: Some medications like antipsychotics and anti-sickness drugs can increase prolactin.
Pituitary gland conditions: The pituitary gland can develop a small area that produces extra prolactin, called a microadenoma (a very small benign growth). In some cases, the abnormality can be larger, and this requires expert multidisciplinary assessment.

Because there are several potential causes, it’s essential that raised prolactin results are interpreted carefully in the right clinical context.

How raised prolactin is investigated

At The London Lauriston Clinic, I provide a comprehensive and efficient assessment for patients with raised prolactin levels.

We have rapid access to biochemical testing and advanced imaging, allowing investigations to be completed promptly and results discussed without delay.

A typical assessment includes:

Detailed medical history and medication review: To identify potential confounders or contributing factors.
Repeat prolactin test: Ideally performed under calm conditions to avoid stress-related elevations. We can undertake resting prolactin levels and macroprolactin levels.
Additional hormone testing: Including thyroid function tests, reproductive hormone levels, and other pituitary hormones to provide a complete picture of pituitary function.
MRI scan of the pituitary gland: To look for small (microadenoma) or occasionally larger areas of overactivity.

If an abnormality is found in the pituitary gland, most are very small (microadenomas) and can be managed medically. Occasionally, the finding may be larger, and in those cases, expert multidisciplinary assessment is arranged to determine the best management plan.

The nerves that carry visual signals from the eyes pass very close to the pituitary gland. For this reason, if a pituitary abnormality is seen, it’s important to include a careful assessment of vision. Where the vision is affected, rapid and precise treatment is needed to protect sight and address the underlying cause.

Treatment options

Treatment depends on the underlying cause and whether symptoms are present.

Addressing reversible causes such as medication adjustments or managing stress.
Managing pituitary prolactinomas; often treated successfully with dopamine agonist medications, which lower prolactin levels and shrink the pituitary lesion. Lowering prolactin is usually straightforward with these medications, but they can cause side effects, which need to be discussed and monitored carefully.
Monitoring. In mild or transient cases, regular follow-up may be all that’s required.

At The London Lauriston Clinic, Ï work within a multidisciplinary pituitary team, collaborating with radiologists, neurosurgeons, and ophthalmologists when appropriate.

I strongly believe in shared decision-making, ensuring patients fully understand the potential causes, investigations, and treatment options. Each management plan is individualised and clearly explained, so patients feel informed and supported throughout their care.

When to see an endocrinologist

You should seek specialist advice if you experience:

Irregular or missed periods
Difficulty conceiving
Breast discharge (galactorrhoea)
Low libido, reduced testosterone levels or infertility (men)
Headaches or vision changes
An unexplained raised prolactin result after a blood test

Early assessment helps confirm the cause and ensures that any necessary treatment begins promptly.

At The London Lauriston Clinic, I offer expert, compassionate care for all hormonal and pituitary disorders, including raised prolactin levels, prolactinomas, thyroid disorders, adrenal conditions, and other endocrine problems.

About Dr Umasuthan Srirangalingam

Dr Srirangalingam is a consultant endocrinologist in London specialising in pituitary, thyroid, and adrenal disorders. He sees private patients at The London Lauriston Clinic, providing expert, personalised care for all aspects of hormonal health.