Sandbox:Mydah

Associate Editor(s)-in-Chief: Mydah Sajid, MD[1]

Hyperprolactinemia resident survival guide

Overview

This section provides a short and straight to the point overview of the hyperprolactinemia.

Causes

Life-threatening Causes

Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.

• Severe burns on the chest can cause hyperprolactinemia due to neural stimulation similar to suckling.

Common Causes

• Pregnancy
• Lactation
• Prolactinoma
• Injury to dopaminergic neurons in the hypothalamus (sarcoidosis, craniopharyngioma, and metastatic brain carcinoma)
• Section of the hypothalamic-pituitary stalk
• Antipsychotics (risperidone, haloperidol, and phenothiazine)
• Selective serotonin reuptake inhibitors
• Metoclopramide
• Domperidone
• Methyldopa
• Verapamil
• Familial hyperprolactinemia
• Hypothyroidism
• Chronic renal failure
• macroprolactinomas
• Exercise

Evaluation

Shown below is an algorithm summarizing the diagnosis of hyperprolactinemia according to an Endocrine Society Clinical Practice guidelines:

Suggestive symptoms including headache, oligomenorrhea, infertility, hypogonadism, erectile dysfunction, and galactorrhea

Detailed history and physical examination should be performed to rule out hypothyroidism, chronic renal failure, and the use of medications known to cause hyperprolactinemia.

Serum prolactin measured. The cut-off values of serum prolactin for hyperprolactinemia are greater than 20 ng/ml in men and postmenopausal women and greater than 30ng/ml in premenopausal women.

MRI with the contrast of brain should be performed to rule out any mass in the hypothalamic-pituitary region.

The levels of other pituitary hormones should be evaluated. The following hormone levels should be evaluated: Plasma corticotropins (ACTH), Serum TSH, Insulin-like growth factors, Follicle-stimulating hormone, Luteinizing hormone, Estradiol/ Testosterone