Prolactin is a peptide hormone produced by the anterior pituitary gland, primarily associated with lactation and plays vital role in breast development during pregnancy. Hyperprolactinemia may cause production and spontaneous flow of breast milk and disruption in the normal menstrual period in women and hypogonadism, infertility and erectile dysfunction in men.
Hyperprolactinemia is the presence of abnormally high levels of prolactin in the blood. Normal levels are less than 580mlU/L for women, and450mlU/L for men.
Hyperprolactinemia can be a part of normal body changes during pregnancy and breast feeding. It can also be caused by disease affecting the hypothalamus and pituitary gland. It can also be caused by the normal regulation of prolactin levels by drugs, other organs such as the liver, kidneys, ovaries and thyroid.
Hyperprolactinemia may be caused by another disinhibition (e.g., compression of the pituitary stalk or reduced dopamine levels or excess production from a prolactinoma, a pituitary gland tumor).
There is a suspicion that Minoxidil, a potassium channel agonist, may be related to the development of this disease. A two year test with Minoxidil, under normal dosing parameters, carried out on rats, which caused pheochromcytomas in both male and females preputial gland adenoma in males.
Physiological causes (i.e., as a result of normal body functioning) pregnancy, breastfeeding, mental stress, sleep, hypothyroidism.
Use of prescription drugs is the most common cause of hyperprolactinemia. Prolactin section in the pituitary is normally suppressed by the brain chemical dopamine. Drugs that block the effects of dopamine at the pituitary or deplete dopamine pituitary to the brain may cause the pituitary to secrete prolactin.
In women a high level of prolactin often cause hypoestrogenism with anovulatory infertility and a decrease in menstruation. In some women menstruation may disappear altogether (amenorrhea). In others menstruation may become irregular or menstrual flow may change. Women who are not pregnant or nursing may begin producing breast milk. Some women may experience libido (interest in sex) and breast pain, especially when prolactin levels begin to rise for the first time, as the hormone promotes tissue changes in the breast. Intercourse may become painful because of vaginal dryness.
In men, the most common symptoms of hyperprolactinemia are decreased libido, erectyle dysfunction, infertility and Gynecomastia. Because men does not have menstruation to signal the problem, hyperprolactinemia caused by an adenoma may delay going to the doctor until they have headaches or eye problems caused by the enlarged pituitary pressing against the optic nerves.
Treatment is usually medication with dopamine agonist such as cabergoline, bromocriptine (often preferred when pregnancy is possible) and less frequently lisuride. A new drug in use is norprolac with the active ingredient quinagolide.
Vitex agnus-cactus extract can be tried in causes of mild hyperprolactinemia.
Billing and Coding
253.1 - Other and unspecified anterior pituitary hyper functions, Forbes Albright Syndrome