Hyperprolactinemia

What is hyperprolactinemia?

Hyperprolactinemia is a common endocrine disorder of the hypothalamic-pituitary axis. In this condition the serum prolactin level is elevated. The diagnosis of hyperprolactinemia is made when serum prolactin levels are found on two separate occasions to be above the norm established for the laboratory used (usually 20 to 25 ng/mL or 400 to 500 mU/L. It can occur in both gender.

 

What are the common causes of elevated prolactin level ?

A prolactinoma is the most common cause of chronic hyperprolactinemia once pregnancy, primary hypothyroidism, and drugs that elevate serum prolactin levels have been excluded.

 

What are the common drugs that cause hyperprolactinemia? 

These drugs include:  The major tranquillizers (phenothiazines),trifluoperazine,and haloperidol; antipsychotic medications in general; metoclopramide, domperidonecisapride used to treat gastro-oesophageal reflux and medication induced nausea (such as cancer drugs); and, less often, alpha-methyldopa and reserpine, used to control hypertension; and oestrogens.

 

What is galactorrhea?

Galactorrhea or galactorrhoea is the flow of milk from the breast, unassociated with childbirth or nursing. Elevated prolactin can cause galactorrhea. Sometimes milk discharge from breast occurs even in the setting of a normal prolacton level (idiopathic galactorrhea). If the discharge is blood stained possibility of a tumor in the breast should be considered.

 

What are symptoms of hyperprolactinemia?

Galactorrhea is a common symptom of hyperprolactnemia. Other symptoms of hyperprolactinemia are infertility, decreased libido, acne, hirsutism and menstrual irregularity. The patient’s menstrual history is important because hyperprolactinemia, through its effect on gonadotropin-releasing hormone, may cause low estrogen levels. As a result, the patient may have amenorrhea or oligomenorrhea, as well as decreased bone density. There can be symptoms related to an intracranial mass, such as visual-field defects, cranial nerve palsy and headache. Males can have symptoms related to decreased libido, erectile dysfunction and infertility.