Hyperprolactinemia is a disorder marked by the overproduction of prolactin (one of eight hormones produced by the pituitary gland) in both men and nonpregnant women. Affecting about 1 percent of the general population—but nearly 25 percent of women with amenorrhea (absent menses)—it is the most common form of overproduction of hormones by the pituitary.
The pituitary, a peanut-size organ located at the base of the brain, is the most important gland in the body’s endocrine, or hormonal, system. Prolactin induces milk production in women following birth, so levels are high in pregnant women. Although the hormone is also present in small quantities in men and nonpregnant women, elevated levels in these individuals can signal a pituitary tumor and cause other serious problems, such as infertility. Hyperprolactinemia should be evaluated by your doctor.
What Causes Hyperprolactinemia?
- A benign pituitary tumor (adenoma or prolactinoma) is the most common cause of abnormal prolactin overproduction.
- Prolactin levels are typically kept in check by the neurotransmitter dopamine, a substance produced in the brain by the hypothalamus. Decreased dopamine levels, due to a disease of the hypothalamus or a dopamine-blocking drug (such as MAO inhibitors and some antipsychotic drugs), may lead to increased levels of prolactin.
- Many other drugs can raise prolactin levels.
- High-dose estrogen (such as oral contraceptives, but not estrogen replacement therapy) can raise blood prolactin levels.
- People with an underactive thyroid (Hypothyroidism) may have elevated levels of prolactin.
- Chronic kidney failure or cirrhosis (Cirrhosis) may be associated with hyperprolactinemia.
Symptoms of Hyperprolactinemia?
- In women: cessation of menstrual periods (amenorrhea), decreased menstrual flow (oligomenorrhea), abnormal production of breast milk when not breastfeeding (galactorrhea), excess facial hair (hirsutism), vaginal dryness and pain during intercourse and infertility.
- In men: impotence, infertility, decreased libido and, rarely, enlarged breasts (gynecomastia) and galactorrhea, decreased muscle mass and reduced body hair.
- Headaches and impaired vision may occur as tumor growth exerts pressure within the skull.
There is no way to prevent prolactin-producing pituitary tumors.
- Patient history and physical examination (including an evaluation of thyroid-, kidney-, and liver function).
- Blood tests to measure elevated levels of prolactin.
- MRI (magnetic resonance imaging) to detect a pituitary tumor.
- Thyroid test to diagnose thyroid disorders.
- Computerized Tomography (CT) to determine the presence of a tumor or another abnormality.
How to Treat Hyperprolactinemia
- Treatment for hyperprolactinemia depends on the cause and the severity of the disorder. In some patients, prolactin levels spontaneously revert to normal. Some pituitary tumors may be small enough that treatment is not required, although regular follow-up evaluations are necessary.
- When the disorder is caused by a tumor, the first line of treatment is medication, either bromocriptine or cabergoline. Pergolide may be used as a secondline agent. Therapy may even shrink the tumor. Levels of prolactin usually fall within days of beginning therapy.
- If medication is not tolerated or is unsuccessful in reducing the size of a tumor and lowering prolactin levels adequately, surgical removal may be required.
- Treatment for causes other than tumors varies. Your doctor will determine the appropriate therapy.
When to Call a Doctor
See a doctor if you develop symptoms of hyperprolactinemia. Leakage of milk from your breast should be evaluated by your doctor.
Johns Hopkins Symptoms and Remedies: The Complete Home Medical Reference
Simeon Margolis, M.D., Ph.D., Medical Editor
Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50
Updated by Remedy Health Media