Hyperprolactinemia

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  1. Causes
    1. Physiologic - nipple stimulation; pregnancy; postpartum; stress
    2. Pathologic - hypothalamic tumors, sarcoid, histiocytosis X, pituitary tumors; primary hypothyroidism; chronic renal failure; bronchogenic carcinoma
    3. Drugs - phenothiazines; tricyclic antidepressants; oral contraceptives
  2. Prolactin is under tonic inhibition by the hypothalamic dopamine
  3. Typically produces galactorrhea, oligoamenorrhea or amenorrhea and androgen excess in women
    1. in men typically see loss of libido and potency, headache, and fatigue
    2. prolactin is normally concerned with breast development and milk production
  4. Thyrotropin releasing hormone (TRH) stimulation test is the best way to diagnose and should cause a two-fold increase in prolactin levels
    1. TRH stimulates increased secretion of both TSH and prolactin (PRL) so occasionally hypothryoidism may mimic hyperprolactinemia
    2. less than two-fold increase is abnormal and consistent with a prolactinoma
    3. high basal PRL plus suboptimal response to TRH is diagnostic
  5. Treatment: discontinue drugs that stimulate PRL release, estrogen replacement ( for hypogonadism), dopaminergic drugs (bromocriptine, cabergolide, quinagolide), radiation ( risk for panhypopituitarism), surgery
    1. NOTE: dopamine will cause increased plasma levels of FSH and LH and decreased levels of prolactin
  6. Differential diagnosis: hypothyroidism, pregnancy, psychiatric medicines
  7. Treatment: bromocriptine - a potent dopamine agonist, acts directly on dopamine receptor
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