II. Causes: Timing of increases

  1. Very brief increases in Prolactin (hours)
    1. Meals
    2. Clozapine
    3. Generalized Tonic-Clonic Seizure
    4. Sexual intercourse
  2. Transient increase in Prolactin levels (days to weeks)
    1. First-generation Antipsychotic Medications (e.g. Haloperidol)
    2. Second-generation Antipsychotic Medications (except Clozapine)
    3. Recent Alcohol or nicotine use
  3. Sustained increase in Prolactin levels (weeks to months)
    1. Exogenous Estrogen
    2. Pregnancy
    3. Lactation
    4. Narcotics
    5. Chronic Renal Failure
    6. Cirrhosis
    7. Prolactinoma
  4. References
    1. Naus (2009) Federal Practitioner p. 44-9
    2. Haddad (2001) J Psychopharmacol 15(4):293-5 [PubMed]

III. Causes: Physiologic

  1. Breast stimulation
  2. Sexual Intercourse
  3. Eating or Dehydration
  4. Exercise
  5. Sleep
  6. Stress
  7. Lactation
  8. Pregnancy or Puerperium
    1. Prolactin levels may reach 200 mcg/L
    2. Resolves within 6 months postpartum
  9. Neonatal Galactorrhea (Witch's Milk)
    1. Resolves in first 2 months of life

IV. Causes: Medications

V. Causes: Non-Neoplastic

  1. Afferent Neural Stimulation
    1. Mechanism
      1. Chest wall Sensory Nerve signal passed via spinal cord to Hypothalamus
      2. Signal reduces Dopamine levels, which in turn generate less inhibition of Prolactin secretion
    2. Breast
      1. Chronic Breast Abscess
      2. Excessive nipple or Breast manipulation
        1. Irritating clothes
        2. Ill-fitting brassieres
    3. Chest Wall and Skin
      1. Herpes Zoster
      2. Mastectomy or other Breast surgery
      3. Thoracotomy
      4. Burn Injury
    4. Spinal Cord tumor, injury or surgery
      1. Syringomyelia
      2. Tabes Dorsalis
  2. Endocrine
    1. Adrenal Adenoma or tumor
    2. Hypothyroidism (related to TRH increase)
    3. Ovarian tumor
    4. Polycystic Ovary Disease
    5. FSH-Secreting Tumor (related to Estrogen increase)
  3. Prolactin Inhibiting Factor (PIF) synthesis Inhibition
    1. Hypothalamic cause
    2. Cerebrovascular Accident (Infarction)
    3. Infiltrative Disease
      1. Encephalitis or post-Encephalitis
      2. Hemochromatosis
      3. Histiocytosis
      4. Sarcoidosis
      5. Tuberculosis
      6. Schistosomiasis
      7. Schuller-Christian Disease
    4. Irradiation
    5. Pseudocyesis
    6. Parkinson's Disease
  4. Prolactin Inhibiting Factor (PIF) transport interrupted
    1. Pituitary stalk section interrupted
    2. Pituitary Stalk compression
      1. Cerebral Aneurysm
      2. Cerebral cyst
      3. Empty sella syndrome
      4. Pseudotumor Cerebri
      5. Rathke's Cleft Cyst
  5. Other non-neoplastic causes
    1. Acute Intermittent porphyria
    2. Hepatic Cirrhosis
    3. Multiple Sclerosis
    4. Chronic Kidney Disease (Chronic Renal Failure or Renal Insufficiency)
      1. Prolactin levels may reach 1000 mcg/L

VI. Causes: Neoplastic

  1. Hypothalamic Dopamine (Prolactin Inhibiting Factor or PIF) deficiency
    1. Hypothalamic Dopamine synthesis inhibition
      1. Hypothalamic Tumors
        1. Craniopharyngioma
        2. Germinoma
        3. Meningioma
        4. Metastases
      2. Pineal Tumors (Primary or metastatic)
    2. Pituitary stalk compression (hypothalamic Dopamine transport interrupted)
      1. Hypothalamic tumor
      2. Pituitary tumor
  2. Prolactin-Secreting tumors
    1. Pituitary tumors
      1. Pituitary Adenoma
        1. ProlactinSecreting tumors represent 40% of pituitary Secreting tumors
      2. Acromegaly
        1. Pituitary Adenomas Secreting Growth Hormone also secrete Prolactin in up to 50% of cases
        2. Growth Hormone also has an independent Lactation effect
      3. Cushing's Disease
      4. Nelson Syndrome (ACTH-Secreting Pituitary Adenoma)
        1. Follows adrenalectomy for Cushing Disease
    2. Ectopic tumor production
      1. Breast Cancer
      2. Bronchogenic Carcinoma
      3. Hypernephroma
  3. Other tumors
    1. Hydatidiform Mole

VII. References

  1. Stenchever (2001) Comprehensive Gynecology, p. 1125-42
  2. Serri (2003) CMAJ 169:575-81 [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 コウプロラクチンケツショウ, コウプ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
Italian Secrezione inappropriata di prolattina, Iperprolattinemia
Korean 고프로락틴혈증
Polish Hiperprolaktynemia, Nadmierne wydzielanie prolaktyny
Hungarian Hyperprolactinaemia
Norwegian Hyperprolaktinemi, For stor danning av prolaktin
Dutch hyperprolactinemie, Hyperprolactinemie, Prolactinehypersecretiesyndroom, Prolactinemie, hyper-, Prolactinesecretie, inadequate

Ontology: Galactorrhea associated with childbirth (C0269995)

Concepts Disease or Syndrome (T047)
ICD9 676.60, 676.6
ICD10 O92.6
SnomedCT 71639005, 65377004
English Galactorrhea, Galactorrhea associated with childbirth, unspecified as to episode of care, LACTATION PUERPERAL INCREASED, Galactorrhea associated with childbirth, Galactorrhoea, Lactation puerperal increased, Galactorrhea preg-unspec, Galactorrhea associated with childbirth, unspecified as to episode of care or not applicable, puerperal galactorrhea - polygalactia, Polygalactia (diagnosis), Persistent secretion of milk associated with childbirth, Polygalactia, Increased postpartum lactation, Increased puerperal lactation, Galactorrhea associated with childbirth (disorder), Galactorrhoea associated with childbirth, Polygalactia (disorder)
Italian Lattazione puerperale aumentata, Galattorrea associata al parto, episodio di cura non specificato
Dutch galactorrhoea veroorzaakt door geboorte kind, niet-gespecificeerd naar behandelperiode, Galactorroe, borstvoeding toegenomen, puerperaal
French Galactorrhée associée à l'accouchement, épisode de soins non précisé, LACTATION PUERPERALE EXCESSIVE, Hypersécrétion lactée puerpérale
German Galaktorrhoe, assoziiert mit Geburt, ohne Angabe der Behandlungsepisode, Galaktorrhoe, LAKTATION GESTEIGERT, Laktation gesteigert
Portuguese Galactorreia associada a parto, episódio de cuidados NE, LACTACAO PUERPERAL AUMENTADA, Lactação puerperal aumentada
Spanish Galactorrea asociada al parto, sin especificación del episodio de asistencia, hipergalactia (trastorno), SECRECION LACTEA PUERPERAL AUMENT, galactorrea asociada con el parto (trastorno), galactorrea asociada con el parto, hipergalactia, lactancia posparto aumentada, lactancia postparto aumentada, secreción persistente de leche asociada con el parto, Lactación puerperal aumentada, poligalactia (trastorno), poligalactia
Japanese 産褥期乳汁分泌増加, 分娩に伴う乳汁漏出症、治療経過詳細不明, ブンベンニトモナウニュウジュウロウシュツショウチリョウケイカショウサイフメイ, サンジョクキニュウジュウブンピツゾウカ, サンジョクキニュウジュウブンピゾウカ
Czech Zvýšená laktace v šestinedělí, Galaktorea související s porodem, bez určení vztahu k péči
Korean 젖흐름증
Hungarian Gondozás időpontjával nem összefüggő, szüléshez kapcsolódó galactorrhoea, Fokozott puerperalis tejelválasztás