Also, women who produce breast milk when they are not pregnant (galactorrhea) may also have high levels of prolactin. In this article, we will discuss the causes of high prolactin levels, symptoms, diagnosis, and treatment.
What is hyperprolactinemia?
Hyperprolactinemia is a condition when there are abnormally high levels of the hormone called prolactin in the blood. Prolactin is produced by the anterior pituitary gland. The primary functions of prolactin is to enhance breast development during pregnancy and to help in the production of breast milk after childbirth.
So, high prolactin levels are expected during pregnancy and while breastfeeding. High levels of prolactin can also affect the levels of hormones such as estrogen, progesterone, and testosterone in men and women.
What are the common causes of high prolactin levels
Common causes of hyperprolactinemia include:
-Prolactinomas: These are tumors that grow on the pituitary gland producing high levels of prolactin. These tumors are usually small and benign meaning they are not cancerous. The symptoms differ according to sex and include headaches and vision problems.
-Prescription medicines for conditions like:
- Hypertension(calcium channel blockers and methyldopa)
- Depression
- Nausea and vomiting
- Pain(opiates)
- Heartburn and gastroesophageal disorders
- Mental health disorders( Risperdal and haloperidol)
- Menopausal symptoms (estrogen)
-Hypothyroidism: A condition where the thyroid gland is not producing enough thyroid hormones.
-Cirrhosis of the liver
-Cushing syndrome
-Chest wall injuries or conditions like shingles
-Herbs like red clover and fenugreek
What are the symptoms of high prolactin levels
High prolactin levels can cause symptoms that vary according to sex.
In women it can cause:
- Irregular or missed periods
- Production of breast milk when not pregnant or breastfeeding
- Infertility
- Vaginal dryness
- Loss of libido
- Breast pain
In men it can cause:
- Erectile dysfunction
- Loss of libido
- Infertility( low sperm production)
- Production of breast milk
- Abnormal growth of breast(gynecomastia)
In some cases, there are no symptoms at all.
How is hyperprolactinemia diagnosed
When hyperprolactinemia is suspected, the doctor will usually ask for a blood test to determine if truly the prolactin levels are elevated. If it is, other tests are carried out to rule out conditions like hypothyroidism.
Doctors will also ask about medications currently being used for other health conditions and pregnancy will also be tested for. If a tumor is suspected, an MRI( magnetic resonance imaging) is done to determine if there is a prolactinoma.
How is hyperprolactinemia treated
Treatment will depend on what the root cause of the high levels of prolactin is and is focused on returning the prolactin levels to normal.
Treatment may include:
- Thyroid replacement drugs if hypothyroidism is the cause.
- Replacement of medicines used to treat other conditions causing the elevation of prolactin levels.
- Surgery, if there is a prolactinoma that is not responding to drugs.
- Drugs
Drugs used to treat hyperprolactinemia
Cabergoline(Parlodel) and bromocriptine are the most common drugs to treat hyperprolactinemia. Treatment with these drugs continues until the symptoms lessen or pregnancy occurs if that is the goal.
Bromocriptine is taken two to three times a day while Cabergoline is long-acting and taken twice weekly under a doctor's supervision. Common side effects are nausea, dizziness, and headache.
Torre DL. (2007). Pharmacological causes of hyperprolactinemia.
