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



  • Predominant age: reproductive age
  • Predominant sex: female (70%) > male (30%)
  • More readily detected in females because a slight elevation in PRL causes changes in menstruation and galactorrhea; men present with headache, visual disturbances, and erectile dysfunction (1)
  • Adenomas in men are typically larger because of delayed onset of symptoms (1).

Etiology and Pathophysiology

  • PRL, which is produced by lactotrophs in the anterior pituitary, is regulated by:
    • Inhibitory factors, primarily dopamine, are 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 or nipple stimulation
      • Stress, including postoperative state
      • Medications: Concentrations are typically in the 25 to 100 ng/mL range (2)[A].
        • Dopamine (D2) blockers: prochlorperazine, metoclopramide
        • Dopamine depleters: α-methyldopa, reserpine
        • Antidepressants: tricyclic antidepressants (TCAs); paroxetine (an SSRI) causes transient hyperprolactinemia—usually resolves in 7 to 10 days
        • Gastric motility drugs: metoclopramide and domperidone
        • Verapamil (but no other calcium channel blockers; thought to decrease the hypothalamic synthesis of dopamine)
        • Older antipsychotics (category is the most common cause of medication induced): haloperidol, fluphenazine, risperidone (level of elevation with risperidone greater than with other antipsychotics)
        • Newer antipsychotics (asenapine, iloperidone, lurasidone) may cause elevation but less than the older antipsychotics (1).
    • Pathologic
      • Hypothyroidism (due to elevated TRH)
      • Chest wall conditions such as herpes zoster, trauma, or postthoracotomy
      • PRL-secreting adenoma in the anterior pituitary (microadenoma: <1 cm; macroadenoma: >1 cm)
      • Pituitary stalk compression/disruption:
        • Craniopharyngioma, Rathke cleft cyst
        • Meningioma, astrocytoma
        • Metastases
        • Head trauma
        • Infiltrative/inflammatory disorders
      • Diminished PRL clearance (chronic renal failure, cirrhosis, cocaine)
    • Idiopathic hyperprolactinemia—a substantial number of cases where the serum levels are between 20 and 100 ng/mL the cause cannot be found (3)[A]


Risk Factors

See causes in “Etiology and Pathophysiology” section.

General Prevention

Avoid offending medications.

Commonly Associated Conditions

  • Infertility
  • Osteoporosis
  • Amenorrhea
  • Gynecomastia

There's more to see -- the rest of this topic is available only to subscribers.