Hyperprolactinaemia – Causes, Symptoms and Treatment
Hyperprolactinaemia is a condition in which prolactin levels in the blood are persistently elevated. It can cause fertility problems, menstrual irregularities, and other hormonal symptoms.
Things worth knowing about "Hyperprolactinaemia"
Hyperprolactinaemia is a condition in which prolactin levels in the blood are persistently elevated. It can cause fertility problems, menstrual irregularities, and other hormonal symptoms.
What is Hyperprolactinaemia?
Hyperprolactinaemia is a medical condition characterised by abnormally high levels of the hormone prolactin in the bloodstream. Prolactin is produced by the pituitary gland at the base of the brain and plays a key role in stimulating breast milk production after childbirth. Outside of pregnancy and breastfeeding, elevated prolactin levels may indicate an underlying condition or a side effect of medication.
Causes
Hyperprolactinaemia can result from a variety of causes:
- Prolactinoma: A benign (non-cancerous) tumour of the pituitary gland that overproduces prolactin. This is the most common pathological cause.
- Medications: Certain drugs, including antipsychotics, antidepressants, antiemetics (e.g. metoclopramide), and antihypertensives, can raise prolactin levels.
- Hypothyroidism: An underactive thyroid gland can trigger elevated prolactin through hormonal feedback mechanisms.
- Renal insufficiency: Reduced kidney function impairs the clearance of prolactin from the body.
- Stress and physical exertion: Prolactin levels may transiently rise in response to stress, exercise, or sleep deprivation.
- Idiopathic hyperprolactinaemia: In some cases, no clear cause can be identified.
Symptoms
The symptoms of hyperprolactinaemia differ between males and females:
In Women
- Irregular or absent menstrual periods (oligomenorrhoea or amenorrhoea)
- Infertility
- Spontaneous milk discharge from the breasts unrelated to pregnancy or breastfeeding (galactorrhoea)
- Reduced libido and vaginal dryness
In Men
- Erectile dysfunction and decreased libido
- Reduced sperm production and infertility
- Rarely: breast enlargement (gynaecomastia) or milk discharge
General Symptoms
- Osteoporosis due to a drop in oestrogen or testosterone levels
- Headaches and visual disturbances caused by a large pituitary tumour pressing on surrounding structures
Diagnosis
Diagnosing hyperprolactinaemia involves the following steps:
- Blood test: Measurement of serum prolactin levels, ideally in a fasting, rested state in the morning, as prolactin is stress-sensitive.
- Repeat measurement: To confirm persistently elevated levels.
- Thyroid function tests: To rule out hypothyroidism as a contributing cause.
- MRI of the pituitary gland: To detect a prolactinoma or other pituitary tumours.
- Medication review: To assess whether current medications may be contributing to elevated prolactin.
Treatment
Treatment depends on the underlying cause of hyperprolactinaemia:
Medical Treatment
For prolactinoma and idiopathic hyperprolactinaemia, dopamine agonists are the first-line treatment. These drugs mimic the inhibitory effect of dopamine on prolactin secretion:
- Cabergoline: A modern, well-tolerated agent taken once or twice weekly
- Bromocriptine: An older agent requiring daily dosing, with a higher frequency of side effects
Surgical Treatment
For large tumours (macroprolactinomas) that do not respond to medication, or when vision is threatened by tumour compression of the optic nerve, neurosurgical intervention (typically via a transsphenoidal approach through the nose) may be required.
Addressing the Underlying Cause
If hyperprolactinaemia is caused by medication, switching to an alternative drug is considered when clinically feasible. Treating an underlying hypothyroidism typically normalises prolactin levels without further intervention.
Prognosis
The outlook for hyperprolactinaemia is generally favourable with appropriate treatment. Prolactinomas frequently respond well to dopamine agonist therapy, and many patients achieve long-term normalisation of prolactin levels. Fertility and hormonal balance often recover substantially following successful treatment.
References
- Melmed S, Casanueva FF, Hoffman AR et al. - Diagnosis and Treatment of Hyperprolactinemia: An Endocrine Society Clinical Practice Guideline. Journal of Clinical Endocrinology & Metabolism, 2011.
- Schlechte JA. - Prolactinoma. New England Journal of Medicine, 2003; 349(21): 2035-2041.
- Casanueva FF, Molitch ME, Schlechte JA et al. - Guidelines of the Pituitary Society for the diagnosis and management of prolactinomas. Clinical Endocrinology, 2006; 65(2): 265-273.
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