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Basics
Description
Hyperprolactinemia is an abnormal elevation in the serum prolactin level with multiple possible etiologies.
Epidemiology
Prevalence
- Predominant age: Reproductive age
- Predominant sex: Female > Male
- More readily detected in females because a slight elevation in prolactin causes changes in menstruation and galactorrhea.
Etiology
- Prolactin, which is produced by lactotrophs in the anterior pituitary, is regulated by:
- Inhibitory factors, primarily dopamine, produced in the hypothalamus and delivered via the hypothalamic-pituitary vessels in the pituitary stalk
- Stimulatory factors, primarily thyrotropin-releasing hormone (TRH)
- Causes of hyperprolactinemia include:
- Physiologic:
- Pregnancy
- Breastfeeding
- Nipple stimulation
- Stress, including postoperative state
- Medications:
- Dopamine (D2) blockers: Antipsychotics (1), metoclopramide
- Dopamine depleters: α-methyldopa, reserpine
- Opiates
- Verapamil (but no other calcium-channel blockers; thought to decrease hypothalamic synthesis of dopamine)
- Possibly antidepressants (minimal data)
- Hypothyroidism (due to elevated TRH)
- Chest wall conditions:
- Herpes zoster
- After thoracotomy
- Trauma
- Prolactin-secreting adenoma, categorized:
- Microadenoma: ≤1 cm
- Macroadenoma: >1 cm
- Pituitary stalk compression/disruption:
- Craniopharyngioma
- Rathke cleft cyst
- Meningioma
- Astrocytoma
- Metastases
- Head trauma
- Infiltrative/Inflammatory disorders
- Diminished prolactin clearance:
- Renal failure
- Cirrhosis
- Physiologic:
- Cocaine
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