Hyperprolactinemia

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What is Hyperprolactinemia?

Hyperprolactinemia is a condition of abnormally high levels of Prolactin in the blood. Prolactin is one of several hormones, produced by the pituitary gland and stimulates milk production in the breast. The main, normal function of Prolactin is during and after pregnancy. During pregnancy, the Prolactin secretion increases and stimulates growth of the breast, but high levels of Estrogen and Progesterone hormones prevent milk production. After delivery, the Estrogen and Progesterone levels drop and Prolactin stimulates the production of milk by the alveolar cells in the breast.

Prolactin is also responsible for absence of menses during pregnancy and for a few months after delivery. Prolactin also affects the levels of sex hormones such as estrogen and testosterone in both women and men.

What are the Causes of Hyperprolactinemia?

Hyperprolactinemia occurs due to both natural and unnatural causes such as:
  • Pregnancy: This is a natural cause for Hyperprolactinemia.
  • Stress: High stress levels are known to cause high blood levels of Prolactin.
  • Chest Wall Injury: Pain in the chest wall, shingles involving the chest wall, breast stimulation and bronchogenic carcinoma. can cause an increase in the amount of Prolactin in the blood.
  • Pituitary Tumors: Abnormal elevations in Prolactin can occur when Prolactin producing cells inside the pituitary gland, grow abnormally to form tumors known as Prolactinoma and produce more than the normal secretion of the hormone Prolactin.
  • Hypothyroidism: Low levels of thyroid hormones can cause raised levels of Prolactin and is a common cause of hyperprolactinemia. This condition is treatable with thyroid hormone replacement therapy.
  • Side Effect of Psychiatric Medications: Many anti depressants and anti psychotic drugs such as Risperidone, Phenothiazines, Haloperidol, Paliperidone, are known to raise Prolactin levels in your body.
  • Side Effects of Drugs: Narcotics, oral contraceptives and drugs to control hypertension are known causes to raise blood Prolactin levels.
  • Liver disease such as cirrhosis
  • Chronic kidney disease
  • During orgasm or sexual stimulation
  • Spinal cord lesion
  • Pituitary and Hypothalamic diseases: Acromegaly, Cushing's disease
  • Metastases, tuberculosis, hemochromatosis
  • Radiation to skull
Causes of Hyperprolactinemia

What are the Symptoms and Signs of Hyperprolactinemia?

The symptoms and signs in both men and women as applicable to the gender, include:
  • Mood swings and decreased libido
  • Acne and excessive body and facial hair growth (hirsutism)
  • Menopausal symptoms (hot flashes and painful sex due to vaginal dryness)
  • Osteoporosis (thinning and weakening of the bones) and osteopenia
  • Additional symptoms such as headaches and visual disturbances may occur if hyperprolactinemia is due to a pituitary tumor.
Symptoms and Signs of Hyperprolactinemia

Men may have symptoms such as:
  • Erectile dysfunction or Impotency
  • Low sperm count
  • Breast enlargement
  • Loss of libido
  • Hypogonadism, as the excess prolactin interferes with secretion of gonadotropin releasing hormone which results in decreased testosterone hormones in men.

How do you Diagnose Hyperprolactinemia?

The diagnosis of hyperprolactinemia is based on a patientís individual symptoms, medical history, medication use, and also ruling out pregnancy in a woman.
  • Thyroid Tests: These tests are done to rule out hypothyroidism as a cause of hyperprolactinemia.
  • MRI of the Brain and Pituitary: MRI is short for Magnetic Resonance Imaging and thisprocedureuses a special machine that creates images of body tissues that help to diagnose a pituitary tumor. An MRI can reveal the size of a Prolactinoma (benign tumor of the pituitary gland that produces the hormone Prolactin).
  • Blood Tests: A blood test is done to measure the amount of Prolactin in the blood. Prolactin levels above 25 nanogram/milliliter, in women who are not pregnant, are considered elevated.
Blood Test can Measure Increased Prolactin Levels in the Blood

How do you Treat Hyperprolactinemia?

The treatment options include:
  • Medications: Bromocriptine and Cabergoline are mostly used to treat hyperprolactinemia. These medications limit the production of Prolactin from the pituitary and Prolactin levels drop in about two to three weeks. These medicines mimic dopamine (a brain chemical) and are used for a majority of patients suffering from elevated Prolactin.
  • Thyroid hormone: Hyperprolactinemia is treated with synthetic thyroid hormone if hypothyroidism is the causative factor.
  • Surgical treatment: This is the treatment of choice for high Prolactin level due to a large pituitary tumor (macroadenoma). This surgical procedure is known as Transsphenoidal Adenoma Resection.
  • Radiation therapy: This therapy usually follows the surgical treatment.

How do you Prevent Hyperprolactinemia?

There are no proven methods to prevent unnatural hyperprolactinemia. However, detecting the causative factor early and treating the same effectively is the best option.

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