Hyperprolactinaemia

Specialty of Endocrinology, diabetes & metabolism

What is hyperprolactinaemia?

Hyperprolactinaemia is a condition caused by abnormally high levels of prolactin in the blood. Prolactin is a hormone produced by a gland located at the base of the head. In women, it is responsible for milk production during pregnancy (galactorrhoea) and for breast development during puberty (together with oestrogen). In men, it is associated with sexual desire, gynaecomastia and impotence. One of its functions is indeed to lower testosterone levels and to mobilise fatty acids.

Prognosis

Usually, the outlook for hyperprolactinaemia greatly depends on what causes it, on your age and overall state of health.

What are the symptoms?

One of the most common symptoms in women is an alteration in the menstrual pattern.

  • Other symptoms in women include vaginal dryness, milk production not associated with childbirth, low progesterone levels after ovulation, oligomenorrhoea, and amenorrhoea;
  • In men, the symptoms include galactorrhoea, gynaecomastia (an increase in the size of male breast tissue), impotence, sexual desire reduction, infertility, muscle mass loss, and body hair loss.

What causes it?

You will need to do a blood test to check the levels of prolactin in your blood. Should prolactin levels be elevated, you will do a head X-ray scan (specifically looking at the pituitary gland and hypothalamus) to determine whether there are microadenomas or adenomas in the pituitary gland or nearby it. In case there’s a tumour mass in the optic chiasma, you may experience vision disorders. In that case, you should do a visual field test.

What causes it?

Hyperprolactinaemia could be caused by physiological, pathological, neurological or pharmacological factors.

Physiological factors include:

  • Pregnancy;
  • Puerperium or post-partum period;
  • Stress;
  • Exercising;
  • Sleep;
  • High protein intake;
  • Breastfeeding;
  • Sexual intercourse;

Pathological causes include:

  • Pituitary adenoma and prolactinoma (a benignant tumour that secretes prolactin);
  • Non-secretory pituitary adenomas;
  • Acromegaly;
  • Empty sella syndrome (ESS);
  • Cushing syndrome;
  • Meningioma (malignant tumour of the meninges);
  • Dysgerminoma (testicular cancer);
  • Sarcoidosis;

 Pharmacological causes or drug-induced hyperprolactinaemia: 

  • Tricyclic antidepressants;
  • Anti-epileptic drugs;
  • Anti-hypertensive agents;
  • Antiemetics (against nausea and vomiting);
  • Antihistamines;

Neurological causes:

  • Herpes zoster (shingles)lesions;
  • Spinal injury;

Other causes:

How is it treated?

Asymptomatic hyperprolactinaemia requires no special treatments. In other cases, the treatment largely depends on what causes it.

Which doctor should I talk to?

To accurately diagnose and treat hyperprolactinaemia, you should see an endocrinologist.

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