What is Hyperprolactinemia?

diagnosis and treatment hyperprolactemia
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Question: What is Hyperprolactinemia?

Answer:

Prolactin is a hormone secreted by the pituitary gland in the brain. Its primary function is to enhance breast development and initiate lactation. Hyperprolactinemia occurs when higher than normal levels is found in the blood. Typically, serum or blood levels are less than 20 ng/ml.

Causes

Prolactin may be elevated for a few reasons. The first is a benign, pituitary tumor, known as a pituitary microadenoma or prolactinoma.

This tumor is not cancerous but can cause increased secretion of prolactin and cause pressure on surrounding tissues. 

Cushing's syndrome occurs when the pituitary releases excess cortisol being made. This can result from a pituitary tumor or other growth.

Hyperprolactinemia can also be caused by an imbalance in the hormones which control the secretion. Hypothyroidism can also cause hyperprolactinemia.

Certain medications can also raise prolactin levels, such as tricyclic antidepressants (specifically clomipramine and desipramine), certain antipsychotics (i.e., Haldol, Zyprexa and Risperdal), verapamil (for blood pressure), reglan (metoclopramide; an antinausea medication) and acid blockers (H2 blockers). 

Symptoms

Symptoms of hyperprolactinemia may be nonexistent, or women may notice the following:

  • infertility
  • galactorrhea (abnormal lactation) or milk leakage from nipples
  • infrequent or irregular periods
  • Loss of libido
  • Painful or uncomfortable intercourse

Diagnosis

Prolactin can be easily measured through a routine blood test. Because a number of factors can affect the blood values, one should avoid breast stimulation and intercourse the night before the test. If the blood test comes back elevated, the doctor may wish to repeat the test, this time after fasting for at least 8 hours.

An MRI may be ordered to look for evidence of a pituitary growth or for damage to surrounding tissues. Blood tests to assess the production of other pituitary hormones may be done and can be helpful to rule out other conditions causing similar symptoms. 

Treatment

The goal of treatment is to bring prolactin levels to normal levels and if possible, shrink the tumor. Generally, two options are available for treating high prolactin levels. The first is medication. The two most commonly prescribed medications are bromocriptine and dostinex. Bromocriptine is typically prescribed first, and can also be used to shrink a pituitary microadenoma in most cases. If the patient cannot tolerate bromocriptine, or if the physician feels that bromocriptine is not appropriate for the patient, doxtinex may be prescribed. Both of those drugs encourage the production of dopamine, which will inhibit prolactin secretion. Your doctor will probably want to periodically measure your prolactin levels to determine if therapy is effective.

Medication can sometimes be stopped if prolactin levels return to and remain normal.

Surgery can sometimes be indicated if the medication is not working or tolerated, or if a pituitary tumor is too large and not responding to medical therapy. Your doctor can determine what will work best for you.

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