Hyperprolactinaemia

Hyperprolactinaemia is the increased production of prolactin. It's a relatively rare disorder.

Etiology

hyperprolactinaemia occurs in:

• Prolactinomas – prolactin-producing pituitary adenomas – most common cause
• Damage to the hypothalamus and infundibular stalk – as this impairs the dopamine-mediated inhibition of prolactin
• Hypothyroidism – as TRH stimulates prolactin
• Dopamine antagonists
• Chronic renal failure – due to decreased excretion

Clinical features

The most common symptoms of hyperprolactinaemia are:

• Decreased gonadotropic effects
  • Hypogonadism
  • Amenorrhea
  • Infertility
  • Gynecomastia
  • Decreased libido
• Galactorrhoea – non-physiological milk discharge
• Bilateral hemianopsia – if caused by a tumor which compresses the optic chiasm

The cause of the decreased gonadotropic effects should be explained. As the level of prolactin is high will the body try to counteract this by producing more dopamine, which usually suppresses prolactin production. Dopamine fails to do this however, but it does suppress the production of GnRH, which decreases LH and FSH, which decreases testosterone and oestrogen production.

Management

The treatment of choice is dopamine agonists and treating the underlying cause.