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Hyperprolactinemia

Hyperprolactinemia is a topic covered in the 5-Minute Clinical Consult.

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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 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
      • 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: 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

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Citation

Stephens, Mark B., et al., editors. "Hyperprolactinemia." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116298/all/Hyperprolactinemia.
Hyperprolactinemia. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116298/all/Hyperprolactinemia. Accessed April 24, 2019.
Hyperprolactinemia. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116298/all/Hyperprolactinemia
Hyperprolactinemia [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 24]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116298/all/Hyperprolactinemia.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Hyperprolactinemia ID - 116298 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116298/all/Hyperprolactinemia PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -