Diagnosis and management of hyperprolactinemia

Abstract

Prolactin is a pituitary hormone that plays a pivotal role in a variety of reproductive functions. Hyperprolactinemia is a common condition that can result from a number of causes, including medication use and hypothyroidism as well as pituitary disorders. Depending on the cause and consequences of the hyperprolactinemia, selected patients require treatment. The underlying cause, sex, age and reproductive status must be considered. We describe the diagnostic approach and management of hyperprolactinemia in various clinical settings, with emphasis on newer diagnostic strategies and the role of various therapeutic options, including treatment with selective dopamine agonists.

Fig. 1: Causes of hyperprolactinemia. Prolactin (PRL) is under dual control from the hypothalamus, where dopamine serves as an inhibitory signal, preventing PRL secretion, and thyrotropin-releasing hormone (TRH), under some conditions, stimulates increased PRL production and release. Increased anterior pituitary hormone production can occur from a PRL-producing adenoma or from inflammation (hypophysitis). However, conditions that result in impaired dopamine delivery or enhanced TRH signalling, or both, will also result in increased PRL release. In general, medications result in increased PRL production through their anti-dopaminergic properties. Chest-wall injury and breast stimulation serve as peripheral triggers of autonomic control, which impinge on central neurogenic pathways that attenuate dopamine release into the hypophyseal portal circulation. In some conditions, such as renal or hepatic insufficiency, PRL is cleared less rapidly from the systemic circulation, which results in increased blood levels of PRL. Photo: Myra Rudakewich

Fig. 2: Approach to diagnosis of hyperprolactinemia.

Fig. 3: Approach to management of hyperprolactinemia.

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