Hyperprolactinemia

Aka: Hyperprolactinemia

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II. Causes

  1. See Hyperprolactinemia Causes
  2. See Medication Causes of Hyperprolactinemia
    1. SSRIs account for up to 95% of medication causes

III. Symptoms

  1. Galactorrhea
    1. Occurs in 90% of women with Hyperprolactinemia
  2. Amenorrhea
  3. Infertility

IV. Diagnosis

  1. Galactorrhea with Amenorrhea is pathognomonic for Hyperprolactinemia
  2. Galactorrhea without Amenorrhea is associated with normal Serum Prolactin

V. Imaging: Brain

  1. MRI Brain with IV contrast
    1. Thin cuts through the sella turcica, Hypothalamus and Optic Chiasm
  2. CT Head with cone down sella turcica
    1. Lower Test Sensitivity than MRI for Pituitary Adenoma and associated abnormalities

VI. Approach: Initial Evaluation

  1. See Galactorrhea
  2. Confirm Hyperprolactinemia
    1. Repeat Serum Prolactin
    2. Repeat in 6 months if repeat Prolactin normal
  3. Evaluate for Physiologic Cause
    1. History
      1. Breast stimulation or Lactation
      2. Sexual Intercourse temporally related to lab test
      3. Excessive Eating, Exercise, Sleep or Stress
    2. Labs
      1. Thyroid Stimulating Hormone (Hypothyroidism)
      2. Urine Pregnancy Test
      3. Comprehensive Metabolic Panel (Electrolytes, Serum Creatinine, hepatic panel)
        1. Evaluate for liver disease and renal disease
      4. Consider reproductive Hormone levels if Hypogonadism is present
        1. Serum Estrogen
        2. Serum Testosterone
        3. Follicle Stimulating Hormone
        4. Luteinizing Hormone

VII. Approach: Prolactin 20 to 50 ng/ml

  1. Abnormal Serum Prolactin >18 ng/ml in men, >20 ng/ml postmenopausal women, >30 ng/ml in premenopausal women
  2. Identify medication related Hyperprolactinemia cause
    1. Discontinue Medication Causes of Hyperprolactinemia
    2. Repeat Prolactin in 1-2 months (at least 3 days after medication discontinuation)
  3. No obvious medication cause
    1. Recheck Serum Prolactin in 3 months
    2. Consider lab testing as above (e.g. TSH, HCG)

VIII. Approach: Prolactin 50 to 100 ng/ml

  1. Identify medication related Hyperprolactinemia cause
    1. Discontinue offending medication
    2. Repeat Prolactin in 1-2 months
  2. No obvious medication cause
    1. Obtain CT or MRI Head (cone-down sella turcica)
    2. Imaging Abnormal
      1. Evaluate Pituitary Tumor (see Prolactinoma)
    3. Imaging Normal
      1. Consider Dopamine Agonist (e.g. Bromocriptine, Cabergoline)
        1. Symptomatic Hyperprolactinemia (e.g. bothersome Galactorrhea or Amenorrhea)
      2. Consider hormonal therapy (Estrogen or Testosterone)
        1. Hypogonadism
      3. Repeat evaluation and testing
        1. Repeat Prolactin at 6 month intervals
        2. Repeat CT or MRI Head (cone-down sella) in 1 year

IX. Approach: Prolactin >100 ng/ml

  1. Causes
    1. Empty sella syndrome
    2. Pituitary Adenoma (especially if >200 to 250 ng/ml)
    3. Consider medication related Hyperprolactinemia
      1. Less likely to raise the Serum Prolactin this high
  2. Obtain CT or MRI Head (cone-down sella turcica)
    1. Imaging Abnormal
      1. Evaluate Pituitary Tumor (see Prolactinoma)
    2. Imaging Normal
      1. Treatment with Dopamine Agonist (e.g. Bromocriptine, Cabergoline)
      2. Repeat Serum Prolactin every 3 months
      3. Repeat CT or MRI Head (cone-down sella) in 1 year

X. Complications

  1. Osteoporosis (secondary to Hypogonadism)
    1. Consider Bone density scan (DEXA)

XI. References

  1. Bruehlman (2022) Am Fam Physician 106(6): 695-700 [PubMed]
  2. Huang (2012) Am Fam Physician 85(11): 1073-80 [PubMed]
  3. Samperi (2019) J Clin Med 8(12):2203 +PMID: 31847209 [PubMed]

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Related Studies

Ontology: Hyperprolactinemia (C0020514)

Definition (NCI) Abnormally high level of prolactin in the blood.
Definition (CSP) increased levels of prolactin in the blood, which may be associated with amenorrhea and galactorrhea; relatively common etiologies include prolactinoma, medication effect, kidney failure, granulomatous diseases of the pituitary gland, and disorders which interfere with the hypothalamic inhibition of prolactin release; ectopic (non-pituitary) production of prolactin may also occur.
Definition (MSH) Increased levels of PROLACTIN in the BLOOD, which may be associated with AMENORRHEA and GALACTORRHEA. Relatively common etiologies include PROLACTINOMA, medication effect, KIDNEY FAILURE, granulomatous diseases of the PITUITARY GLAND, and disorders which interfere with the hypothalamic inhibition of prolactin release. Ectopic (non-pituitary) production of prolactin may also occur. (From Joynt, Clinical Neurology, 1992, Ch36, pp77-8)
Concepts Disease or Syndrome (T047)
MSH D006966
ICD10 E22.1
SnomedCT 367422005, 190468001, 237662005, 21170004
English Hyperprolactinemias, HYPERPROLACTINAEMIA, INAPPROPRIATE PROLACTIN SECRET SYNDROME, PROLACTIN HYPERSECRET SYNDROME, INAPPROPRIATE PROLACTIN SECRET, PROLACTIN INAPPROPRIATE SECRET, hyperprolactinemia (diagnosis), hyperprolactinemia, Idiopathic hyperprolactinemia [dup], Hyperprolactinemia, Hypersecretion Syndrome, Prolactin, Prolactin Hypersecretion Syndrome, Syndrome, Prolactin Hypersecretion, Inappropriate Prolactin Secretion, Inappropriate Secretion Prolactin, Prolactin Secretion, Inappropriate, Prolactin, Inappropriate Secretion, Secretion Prolactin, Inappropriate, Secretion, Inappropriate Prolactin, Inappropriate Prolactin Secretion Syndrome, Hyperprolactinemia [Disease/Finding], Hyperprolactinaemia, Idiopathic hyperprolactinemia, Hyperprolactinaemia (disorder), Idiopathic hyperprolactinemia (disorder), HYPERPROLACTINEMIA, HPRL, Hyperprolactinemia (disorder), Hyperprolactinaemia, NOS, Hyperprolactinemia, NOS, hyperprolactinaemia
French HYPERPROLACTINEMIE, Hyperprolactinémie, Syndrome de sécrétion inappropriée d'hormone lutéotrope, Syndrome de sécrétion inappropriée de LTH, Syndrome de sécrétion inappropriée de PRL, Syndrome de sécrétion inappropriée de prolactine
Portuguese HIPERPROLACTINEMIA, Hiperprolactinemia, Secreção Inadequada de Prolactina, Síndrome da Hipersecrecão de Prolactina
Spanish HIPERPROLACTINEMIA, hipersecreción de prolactina, hiperprolactinemia (concepto no activo), hiperprolactinemia (trastorno), hiperprolactinemia, Hiperprolactinemia, Secreción Inapropiada de Prolactina, Síndrome de Hipersecreción de Prolactina
German HYPERPROLAKTINAEMIE, Hyperprolactinaemie, Hyperprolaktinaemie, Prolaktin-Hypersekretionssyndrom, Hyperprolaktinämie, Prolaktinämie, Hyper-, Prolaktin, inadäquate Sekretion
Swedish Hyperprolaktinemi
Japanese ｺｳﾌﾟﾛﾗｸﾁﾝｹﾂｼｮｳ, ｺｳﾌﾟﾛﾗｸﾁﾝｹｯｼｮｳ, 過プロラクチン血症, 高プロラクチン血症, 高プロラクチン血
Czech hyperprolaktinémie, Hyperprolaktinemie
Finnish Hyperprolaktinemia
Russian GIPERPROLAKTINEMIIA, ГИПЕРПРОЛАКТИНЕМИЯ
Italian Secrezione inappropriata di prolattina, Iperprolattinemia
Korean 고프로락틴혈증
Croatian HIPERPROLAKTINEMIJA
Polish Hiperprolaktynemia, Nadmierne wydzielanie prolaktyny
Hungarian Hyperprolactinaemia
Norwegian Hyperprolaktinemi, For stor danning av prolaktin
Dutch hyperprolactinemie, Hyperprolactinemie, Prolactinehypersecretiesyndroom, Prolactinemie, hyper-, Prolactinesecretie, inadequate
Derived from the NIH UMLS (Unified Medical Language System)

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