Hyperprolactinemia

Etiology

  • Increased production related to pituitary prolactinoma (micro or macroadenoma)
  • Meds that cause increase prolactin levels→ antipsychotics, opioids, SSRIs, TCAs, verapamil, metoclopramide, others
  • Physiologic: pregnancy and post-partrum
  • Hypothalamic stimulation: hypothyroidism, adrenal insufficiency
  • Decreased clearance of prolactin secondary to CKD, cirrhosis
  • Neurogenic: nipple stimulation, chest wall trauma

Risk Factors

  • Women: age 20-50, premenopausal

Symptoms

  • Galatorrhea
  • Irregular periods
  • Infertility (male and female
  • Headache, visual changes (bi-temporal heminaposia) from pressure on optic chiasm w/large macroadnoma
  • Men tend to present without galactorrhea and thus more advanced disease (i.e. no early warning): low testosterone→ decreased libido, erectile dysfunction, other hypogonadal symptoms

Physical Exam Findings

  • Galactorrhea w/o mass
  • Sometimes bitemporal visual field cuts (if macroadenoma compressing chiasm)