Hyperprolactinemia: Causes, Symptoms and Treatment

Hyperprolactinemia is a medical condition in which the blood level of prolactin hormone rises to alarmingly high levels resulting in some signs and symptoms. This hormone is secreted by the pituitary gland. Male and female presents with different symptoms though some symptoms are common. Prolactin hormone helps in stimulating breast for milk production in females after pregnancy but without pregnancy, Hyperprolactinemia causes the absence of period and abnormal milk secretion. It is more common in women as compared to men. It has a prevalence rate of about 100 per million adult population.

Causes of Hyperprolactinemia

The most common cause is a tumor of the pituitary glands and less common includes drugs and other medical conditions as

• Tumors: Prolactinoma is a tumor of the pituitary gland that produces very high levels of prolactin. They rarely become cancerous. They can be large or small and are more common in females.
• Medications: certain medications may result in increased levels of prolactin level because of their side effects like

                Antidepressants drugs like tricyclic and SSRI

                Antipsychotics drugs used to treat brain disorders like risperidone

                Painkiller like opiates

                Some antihypertensive medications that is CCB (calcium channel blockers)

                Antihistamine used for acidity

• Hormone replacement therapy like estrogen
• Pituitary stalk compression: any brain lesion or injury that can compress stalk of pituitary gland releases prolactin.
• Hypothyroidism – low levels of thyroxine hormones
• Chronic renal failure – due to reduced capacity of kidney to remove prolactin from blood.
• Chest wall injuries or infections
• Idiopathic – in some cases, physicians are not able to find the cause behind it

Symptoms and signs of Hyperprolactinemia

 Male and female are affected differently but some symptoms are common is both as

• Decrease in sex drive or libido
• Bone loss or osteopenia
• Infertility

These symptoms arise because prolactin hormone decreases the level of sex hormones

Women also complain of

• Abnormal menstruation – absence or irregular periods
• Secretion of milk from breast without any recent pregnancy or lactation
• Some weight gains
• Increased facial hairs

Men also complain of

• Abnormal vision
• Reduced muscle mass and decrease beard hairs
• Abnormal secretion from nipples – the growth of breast tissue

Complications of Hyperprolactinemia

• Permanent infertility
• Permanently loss of vision
• Bone fracture

Diagnosis of Hyperprolactinemia

• Medical history: Your doctor will ask you many questions related to symptoms and signs, current or past medications, bowel habits, physical activity
• Physical examination
• Lab tests

Blood test: Morning fasting blood sample is taken to check for the levels of prolactin, thyroxine hormone. If blood levels of prolactin are highly elevated, your doctor would suspect prolactinoma and will order MRI test to confirm it.

MRI: To rule out any lesion or tumor in the pituitary gland or anywhere in the brain which is affecting the pituitary directly.

Kidney function test: If kidney failure is suspected to be the cause of hyperprolactinemia.

Treatment of Hyperprolactinemia

The aim of treatment is to eliminate the cause behind it and to reduce the symptoms of elevated prolactin levels. No treatment is required if there are no symptoms

• Medications: They will decrease the symptoms by decreasing prolactin levels like bromocriptine, cabergoline. These are dopamine agonists. Drugs are the only choices for idiopathic hyperprolactinemia.
• Surgery: Your doctor recommends surgery if symptoms are not responding to medication or the tumor is affecting vision due to nerve compression.
• Radiation: If a person cannot be operated on due to underlying medical conditions.
• Drugs induced hyperprolactinemia: Consult your doctor whether drugs should be withdrawn or it can be replaced by some other drugs having side effects
• For hypothyroidism: Hormone replacement therapy with thyroxine hormone can be given
• Renal transplantation: in patient suffering from renal failure

References

• https://www.niddk.nih.gov/health-information/endocrine-diseases/prolactinoma
• https://www.pituitarysociety.org/
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3483691/