Hyperprolactinemia

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Basics

Description

Hyperprolactinemia is an abnormal elevation in the serum prolactin level, from either physiologic or pathologic influences of the lactotroph cells of the pituitary gland

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 and Pathophysiology

  • 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 the following:
    • Physiologic
    • Pregnancy due to increased estrogen
    • Breastfeeding
    • Nipple stimulation
    • Stress, including postoperative state
    • Medications-concentrations are typically in the 25–100 ng/mL range (1)[A]
      • Dopamine (D2) blockers: prochlorperazine, metoclopramide
      • Dopamine depleters: α-methyldopa, reserpine
      • Antidepressants: selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (SSRIs do not appear to cause clinically significant hyperprolactinemia.)
      • Verapamil (but no other calcium channel blockers; thought to decrease hypothalamic synthesis of dopamine)
      • Antipsychotics: (category is the most common cause of medication induced) haloperidol, fluphenazine, risperidone
    • Hypothyroidism (due to elevated TRH)
    • Chest wall conditions:
      • Herpes zoster
      • After thoracotomy
      • Trauma
    • Prolactin-secreting adenoma (anterior pituitary), 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:
      • Chronic renal failure
      • Cirrhosis
    • Cocaine
    • Idiopathic hyperprolactinemia—when the serum levels are between 20–100 ng/mL but etiology cannot be found (2)[A]

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Basics

Description

Hyperprolactinemia is an abnormal elevation in the serum prolactin level, from either physiologic or pathologic influences of the lactotroph cells of the pituitary gland

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 and Pathophysiology

  • 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 the following:
    • Physiologic
    • Pregnancy due to increased estrogen
    • Breastfeeding
    • Nipple stimulation
    • Stress, including postoperative state
    • Medications-concentrations are typically in the 25–100 ng/mL range (1)[A]
      • Dopamine (D2) blockers: prochlorperazine, metoclopramide
      • Dopamine depleters: α-methyldopa, reserpine
      • Antidepressants: selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (SSRIs do not appear to cause clinically significant hyperprolactinemia.)
      • Verapamil (but no other calcium channel blockers; thought to decrease hypothalamic synthesis of dopamine)
      • Antipsychotics: (category is the most common cause of medication induced) haloperidol, fluphenazine, risperidone
    • Hypothyroidism (due to elevated TRH)
    • Chest wall conditions:
      • Herpes zoster
      • After thoracotomy
      • Trauma
    • Prolactin-secreting adenoma (anterior pituitary), 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:
      • Chronic renal failure
      • Cirrhosis
    • Cocaine
    • Idiopathic hyperprolactinemia—when the serum levels are between 20–100 ng/mL but etiology cannot be found (2)[A]

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