Hyperprolactinemia is a condition characterized by elevated prolactin levels which usually presents with hypogonadism and/or galactorrhea. Common causes include physiological stimuli, drugs that antagonize dopamine or deplete it, primary hypothyroidism, prolactinomas and macroprolactinemia. Management involves correcting underlying causes if possible through cessation of offending drugs or thyroid hormone replacement. Dopamine agonist therapy is used to normalize prolactin levels and restore gonadal function. Prolactinomas are treated with dopamine agonists, surgery or radiation therapy.

1. HYPERPROLACTINEMI
A
SUNAINA RAWAT
303
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2.  Hyperprolactinaemia is a common abnormality
which usually presents with hypogonadism
and/or galactorrhoea (lactation in the absence
of breastfeeding).
 Since prolactin stimulates milk secretion but
not breast development, galactorrhoea rarely
occurs in men and only does so if
gynaecomastia has been induced by
hypogonadism.

3.  Hyperprolactinaemia is a common abnormality
which usually presents with hypogonadism
and/or galactorrhoea (lactation in the absence
of breastfeeding).
 Since prolactin stimulates milk secretion but
not breast development, galactorrhoea rarely
occurs in men and only does so if
gynaecomastia has been induced by
hypogonadism.

4. Causes of
hyperprolactinaemia-1
Physiological
• Stress (e.g. post-seizure)
• Pregnancy
• Lactation
• Nipple stimulation
• Sleep
• Coitus
• Exercise
• Baby crying
Drug-inducedDopamine antagonists
• Antipsychotics (phenothiazines and butyrophenones)
• Antidepressants
• Antiemetics (e.g. metoclopramide, domperidone)

5. Causes of
hyperprolactinaemia-2
Dopamine-depleting drugs
• Reserpine
• Methyldopa
Oestrogens
• Oral contraceptive pill
Pathological-Common
• Disconnection hyperprolactinaemia (e.g. non-functioning pituitary
macroadenoma)
• Prolactinoma (usually microadenoma)
• Primary hypothyroidism
• Polycystic ovarian syndrome
• Macroprolactinaemia

6. Causes of
hyperprolactinaemia-3
Uncommon
• Hypothalamic disease
• Renal failure
• Pituitary tumour secreting prolactin and growth
hormone
Rare
• Chest wall reflex (e.g. post-herpes zoster)
• Ectopic source

7. Causes of
hyperprolactinaemia-3
Uncommon
• Hypothalamic disease
• Renal failure
• Pituitary tumour secreting prolactin and growth
hormone
Rare
• Chest wall reflex (e.g. post-herpes zoster)
• Ectopic source

8. Causes of
hyperprolactinaemia-3
Uncommon
• Hypothalamic disease
• Renal failure
• Pituitary tumour secreting prolactin and growth
hormone
Rare
• Chest wall reflex (e.g. post-herpes zoster)
• Ectopic source

9. Causes of
hyperprolactinaemia-3
Uncommon
• Hypothalamic disease
• Renal failure
• Pituitary tumour secreting prolactin and growth
hormone
Rare
• Chest wall reflex (e.g. post-herpes zoster)
• Ectopic source

10. Causes of
hyperprolactinaemia-3
Uncommon
• Hypothalamic disease
• Renal failure
• Pituitary tumour secreting prolactin and growth
hormone
Rare
• Chest wall reflex (e.g. post-herpes zoster)
• Ectopic source

11. Causes of
hyperprolactinaemia-3
Uncommon
• Hypothalamic disease
• Renal failure
• Pituitary tumour secreting prolactin and growth
hormone
Rare
• Chest wall reflex (e.g. post-herpes zoster)
• Ectopic source
⑧

12. Causes of
hyperprolactinaemia-3
Uncommon
• Hypothalamic disease
• Renal failure
• Pituitary tumour secreting prolactin and growth
hormone
Rare
• Chest wall reflex (e.g. post-herpes zoster)
• Ectopic source

13. Causes of
hyperprolactinaemia-3
Uncommon
• Hypothalamic disease
• Renal failure
• Pituitary tumour secreting prolactin and growth
hormone
Rare
• Chest wall reflex (e.g. post-herpes zoster)
• Ectopic source
⑧

14. Causes of
hyperprolactinaemia-3
Uncommon
• Hypothalamic disease
• Renal failure
• Pituitary tumour secreting prolactin and growth
hormone
Rare
• Chest wall reflex (e.g. post-herpes zoster)
• Ectopic source
⑧

15. Causes of
hyperprolactinaemia-3
Uncommon
• Hypothalamic disease
• Renal failure
• Pituitary tumour secreting prolactin and growth
hormone
Rare
• Chest wall reflex (e.g. post-herpes zoster)
• Ectopic source

16. Causes of
hyperprolactinaemia-3
Uncommon
• Hypothalamic disease
• Renal failure
• Pituitary tumour secreting prolactin and growth
hormone
Rare
• Chest wall reflex (e.g. post-herpes zoster)
• Ectopic source
⑱
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*AlINT
:=
->
Transphenoidal Surgery
=>
Irradiatio
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Medications:-
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Dopamine Agonists:30-40%
v
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17. Management
 If possible, the underlying cause should be corrected
(for example, cessation of offending drugs and giving
thyroxine replacement in primary hypothyroidism).
 If this is not possible, then in almost all cases of
hyperprolactinaemia, dopamine agonist therapy (see
will normalise prolactin levels with return of gonadal
function.
 If gonadal function does not return despite effective
lowering of prolactin, then there may be associated
gonadotrophin deficiency or, in the female, the onset
of the menopause.
 Troublesome physiological galactorrhoea can also be
treated with dopamine agonists.
 Management of prolactinomas is described below.
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18. Management
 If possible, the underlying cause should be corrected
(for example, cessation of offending drugs and giving
thyroxine replacement in primary hypothyroidism).
 If this is not possible, then in almost all cases of
hyperprolactinaemia, dopamine agonist therapy (see
will normalise prolactin levels with return of gonadal
function.
 If gonadal function does not return despite effective
lowering of prolactin, then there may be associated
gonadotrophin deficiency or, in the female, the onset
of the menopause.
 Troublesome physiological galactorrhoea can also be
treated with dopamine agonists.
 Management of prolactinomas is described below.
PREVENTION OF HYPERPROLACTINEMIA
Avoid consuming sugary drinks, processed foods,
and foods that are high in sugar. Also, make sure
to consume enough protein and fibre in your diet.
This will help to keep your blood sugar stable
and help to reduce prolactin levels.
The only known risk factor for developing a
prolactinoma, the most common cause of
hyperprolactinemia, is having an inherited
(passed through the family) condition called
multiple endocrine neoplasia (MEN) type
⑩
.

19. Management
 If possible, the underlying cause should be corrected
(for example, cessation of offending drugs and giving
thyroxine replacement in primary hypothyroidism).
 If this is not possible, then in almost all cases of
hyperprolactinaemia, dopamine agonist therapy (see
will normalise prolactin levels with return of gonadal
function.
 If gonadal function does not return despite effective
lowering of prolactin, then there may be associated
gonadotrophin deficiency or, in the female, the onset
of the menopause.
 Troublesome physiological galactorrhoea can also be
treated with dopamine agonists.
 Management of prolactinomas is described below.
SUNAINA RAWAT
303
AB...
*AY...
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