General Principles

  • In women, the most common causes of pathologic hyperprolactinemia are prolactin-secreting pituitary microadenomas and idiopathic hyperprolactinemia (Table 24-3).
  • In men, the most common cause is a prolactin-secreting macroadenoma.
  • Hypothalamic or pituitary lesions that cause deficiency of other pituitary hormones often cause hyperprolactinemia.
  • Medications are an important cause to consider in all patients.
Table 24-3: Major Causes of Hyperprolactinemia
Pregnancy and lactation
Prolactin-secreting pituitary adenoma (prolactinoma)
Idiopathic hyperprolactinemia
Drugs (e.g., phenothiazines, atypical antipsychotic medications, metoclopramide, verapamil)
Interference with synthesis or transport of hypothalamic dopamine
Hypothalamic lesions
Nonsecretory pituitary macroadenomas
Primary hypothyroidism
Chronic renal failure

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