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| {{SI}} | | __NOTOC__ |
| {{CMG}} | | {{CMG}}; {{AE}} |
| | {{Hyperprolactinemia}} |
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| {{EH}} | | {{SK}} Hyperprolactinaemia; Ahumada-DelCastillo syndrome; Chiari-Frommel syndrome; Forbes-Albright syndrome |
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| ==Overview==
| | '''For patient information click [[Hyperprolactinaemia (patient information)|here]]''' |
| '''Hyperprolactinaemia''' ([[British English|BrE]]) or '''hyperprolactinemia''' ([[American English|AmE]]) is the presence of abnormally high levels of [[prolactin]] in the blood. [[Reference ranges for common blood tests|Normal levels]] are less than 580 mIU/L for women, and less than 450 mIU/L for men. | |
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| The hormone prolactin is downregulated by [[dopamine]] and is upregulated by [[estrogen]]. A falsely high measurement may occur due to the presence of the biologically inactive [[macroprolactin]] in the serum. This can show up as high prolactin in some types of tests, but is asymptomatic.
| | {{Infobox_Disease | |
| | Name = Hyperprolactinemia | |
| | Image = | |
| | Caption = | |
| | DiseasesDB = 6314 | |
| | ICD10 = {{ICD10|E|22|1|e|20}} | |
| | ICD9 = {{ICD9|253.1}} | |
| | ICDO = | |
| | OMIM = | |
| | MedlinePlus = | |
| | MeshID = D006966 | |
| | }} |
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| ==Causes== | | ==[[Hyperprolactinemia overview|Overview]]== |
| Hyperprolactinaemia may be caused by either disinhibition (e.g. compression of the pituitary stalk or reduced dopamine levels) or excess production from a [[prolactinoma]] (a pituitary gland [[adenoma]] tumour). A prolactin level of 1000–5000mIU/L could be from either mechanism, but >5000mIU/L is likely due to an adenoma with macroadenomas (large tumours over 10 mm diameter) having levels of up to 100,000mIU/L. Hyperprolactinemia inhibits [[gonadotropin-releasing hormone]] (GnRH) by increasing the release of [[dopamine]] from the [[arcuate nucleus]] of the [[hypothalamus]] (dopamine inhibits GnRH secretion), thus inhibiting gonadal steroidogenesis, which is the cause of many of the symptoms described below:
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| ===Physiological causes=== | | ==[[Hyperprolactinemia historical perspective|Historical Perspective]]== |
| Physiological causes (i.e. as result of normal body functioning): [[pregnancy]], [[breastfeeding]], [[stress (medicine)|stress]], sleep.
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| ===Prescription drugs=== | | ==[[Hyperprolactinemia classification|Classification]]== |
| Use of prescription drugs are the most common cause of hyperprolactinaemia. Prolactin secretion in the pituitary is normally suppressed by the brain chemical, [[dopamine]]. Drugs that block the effects of dopamine at the pituitary or deplete dopamine stores in the brain may cause the pituitary to secrete prolactin. These drugs include the major [[tranquilizers]] ([[phenothiazine]]s), [[trifluoperazine]] ([[Stelazine]]), ,and [[haloperidol]] ([[Haldol]]); some [[antipsychotic]] medications; [[metoclopramide]] ([[Reglan]]), used to treat [[Gastroesophageal reflux disease|gastroesophageal reflux]] and the nausea caused by certain cancer drugs; and less often, [[methyldopa|alpha-methyldopa]] and [[reserpine]], used to control [[hypertension]]. Finally [[Estrogen|oestrogens]] and [[thyrotropin-releasing hormone|TRH]].
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| ===Diseases=== | | ==[[Hyperprolactinemia pathophysiology|Pathophysiology]]== |
| Prolactinoma or other tumors arising in or near the pituitary—such as those that cause [[acromegaly]] or [[Cushing's syndrome]]—may block the flow of dopamine from the brain to the prolactin-secreting cells, likewise division of the [[pituitary stalk]] or hypothalamic disease. Other causes include [[chronic renal failure]], [[hypothyroidism]] and [[sarcoidosis]]. Some women with [[polycystic ovary syndrome]] may have mildly elevated prolactin levels.
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| Apart from diagnosing hyperprolactinaemia and [[hypopituitarism]], prolactin levels are often determined by physicians in patients who have suffered a [[seizure]], when there is doubt whether this was an [[epileptic seizure]] or a [[non-epileptic seizure]]. Shortly after epileptic seizures, prolactin levels often rise, while they are normal in non-epileptic seizures.
| | ==[[Hyperprolactinemia causes|Causes]]== |
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| ===Idiopathic=== | | ==[[Hyperprolactinemia differential diagnosis|Differentiating Hyperprolactinemia from other Diseases]]== |
| In many patients elevated levels remain unexplained and may represent a form of hypothalamic-pituitary dysregulation.
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| ==Symptoms== | | ==[[Hyperprolactinemia epidemiology and demographics|Epidemiology and Demographics]]== |
| In women, a high blood level of prolactin often causes [[hypoestrogenism]] with anovulatory [[infertility]] and a decrease in [[menstruation]]. In some women, menstruation may disappear altogether ([[amenorrhea]]). In others, mensturation may become irregular or menstrual flow may change. Women who are not pregnant or nursing may begin producing [[breast milk]]. Some women may experience a loss of [[libido]] (interest in sex). [[Intercourse]] may become painful because of vaginal dryness.
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| In men, the most common symptoms of prolactinoma are [[impotence]], decreased [[libido]], [[erectile dysfunction]], and [[infertility]]. Because men have no reliable indicator such as [[menstruation]] to signal a problem, many men with hyperprolactinemia being caused by an adenoma may delay going to the doctor until they have [[headaches]] or eye problems caused by the enlarged pituitary pressing against nearby eye nerves. They may not recognize a gradual loss of sexual function or [[libido]]. Only after treatment do some men realize they had a problem with sexual function.
| | ==[[Hyperprolactinemia risk factors|Risk Factors]]== |
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| Because of hypoestrogenism, hyperprolactinaemia can lead to [[osteoporosis]].
| | ==[[Hyperprolactinemia screening|Screening]]== |
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| | ==[[Hyperprolactinemia natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| ==Diagnosis== | | ==Diagnosis== |
| A doctor will test for prolactin blood levels in women with unexplained milk secretion ([[galactorrhea]]) or irregular [[menses]] or [[infertility]], and in men with impaired sexual function and, in rare cases, milk secretion. If prolactin is high, a doctor will test [[thyroid]] function and ask first about other conditions and medications known to raise prolactin secretion. Whilst a plain [[X-ray]] of the bones surrounding the pituitary may reveal the presence of a large macro-adenoma, the small micro-adenoma will not be apparent. Magnetic resonance imaging ([[MRI]]) is the most sensitive test for detecting pituitary tumors and determining their size. [[MRI]] scans may be repeated periodically to assess tumor progression and the effects of therapy. [[Computed Tomography]] (CT scan) also gives an image of the pituitary, but it is less sensitive than the MRI.
| | [[Hyperprolactinemia history and symptoms|History and Symptoms]] | [[Hyperprolactinemia physical examination|Physical Examination]] | [[Hyperprolactinemia laboratory findings|Laboratory Findings]] | [[Hyperprolactinemia electrocardiogram|Electrocardiogram]] | [[Hyperprolactinemia CT|CT]] | [[Hyperprolactinemia MRI|MRI]] | [[Hyperprolactinemia echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Hyperprolactinemia other imaging findings|Other Imaging Findings]] | [[Hyperprolactinemia other diagnostic studies|Other Diagnostic Studies]] |
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| In addition to assessing the size of the pituitary tumor, doctors also look for damage to surrounding tissues, and perform tests to assess whether production of other pituitary hormones is normal. Depending on the size of the tumor, the doctor may request an eye exam with measurement of visual fields.
| | ==Treatment== |
| | [[Hyperprolactinemia medical therapy|Medical Therapy]] | [[Hyperprolactinemia surgery|Surgery]] | [[Hyperprolactinemia primary prevention|Primary Prevention]] | [[Hyperprolactinemia secondary prevention|Secondary Prevention]] | [[Hyperprolactinemia cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Hyperprolactinemia future or investigational therapies|Future or Investigational Therapies]] |
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| ==Historical eponyms== | | ==Case Studies== |
| On occasion the following eponyms may be encountered:
| | [[Hyperprolactinemia case study one|Case #1]] |
| # Ahumada-DelCastillo Syndrome, refers to the association of galactorrhea and amenorrhea.
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| # Chiari-Frommel Syndrome, refers to extended postpartum galactorrhea and amenorrhea.
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| # Forbes-Albright Syndrome, refers to galactorrhea-amenorrhea associated with a pituitary tumor. | |
| These eponyms were established before prolactin measurements could be done reliably in the clinical setting.
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| == Acknowledgements == | | ==Acknowledgements== |
| The content on this page was first contributed by: C. Michael Gibson, M.S., M.D. | | The content on this page was first contributed by: C. Michael Gibson, M.S., M.D. |
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| | | ==References== |
| {{SIB}} | | {{reflist|2}} |
| {{WH}}
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| {{WS}}
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| [[Category:Disease]] | | [[Category:Disease]] |
| [[Category:Endocrinology]] | | [[Category:Endocrinology]] |
| [[Category:Hormone]]
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| [[Category:Signs and symptoms]]
| | {{WS}} |
| [[Category:Blood tests]]
| | {{WH}} |