[…] hī'pĕr-prō'lak-ti-nē'mē-ă ), Elevated levels of prolactin in the blood, which is a normal physiologic reaction during lactation and pregnancy, but pathologic otherwise; prolactin may also be elevated in cases of certain pituitary tumors, and amenorrhea is often present [medical-dictionary.thefreedictionary.com]

Frequency United States This condition occurs in less than 1% of the general population and in 5-14% of patients presenting with secondary amenorrhea. [3] Approximately 75% of patients presenting with galactorrhea and amenorrhea have hyperprolactinemia [emedicine.com]

We present an immunocompetent pediatric patient who presented with gynecomastia and was found to have hyperprolactinemia. Imaging showed a sphenoid mass and referral was made for a pituitary tumor. [ncbi.nlm.nih.gov]

• Galactorrhea

  Galactorrhea and anestrus results. [medical-dictionary.thefreedictionary.com]

  Patient continued to have galactorrhea, and prolactin level rose for two years without any apparent identified cause, except breast implantation surgery. [ncbi.nlm.nih.gov]

  Definition (MSH) Increased levels of PROLACTIN in the BLOOD, which may be associated with AMENORRHEA and GALACTORRHEA. [fpnotebook.com]

• Asymptomatic

  As for the asymptomatic hyperprolactinemic individuals, macroprolactinemia should be screened, and once it is detected, there is no need for pituitary imaging study or for dopaminergic agonist use. [ncbi.nlm.nih.gov]

• Pain

  When occurring outside of pregnancy or breastfeeding, they may include: Infertility Gallactoria (abnormal lactation) Infrequent or irregular periods Amenorrhea (disappearance of ovulation periods) Loss of libido Breast pain Painful intercourse due to [pcos.about.com]

  Her present complaint was weakness and widespread bone-pain. In routine biochemistry, she had an elevated calcium level of 11.1 (8.6-10.2) mg/dl and her DEXA evaluation was consistent with osteoporosis (vertebra and femur T score <-2.5). [ncbi.nlm.nih.gov]

  These include medicines for: High blood pressure (such as calcium-channel blockers and methyldopa) Depression (tricyclic and SSRI antidepressants) Heartburn and gastroesphageal reflux disease Nausea and vomiting Pain (opiates—drugs derived from opium) [hormone.org]

• Antipsychotic Agent

  Typical antipsychotic agents are more likely to cause hyperprolactinemia than atypical antipsychotic agents, with the exception of amisulpride, paliperidone, and risperidone. [ncbi.nlm.nih.gov]

  agents, a link exists between hyperprolactinemia and an increase in markers of activated coagulation, suggesting that these men are at increased risk for venous thromboembolism. [emedicine.com]

• Fatigue

  Meta-analysis of insomnia, headache, sedation, psychiatric disorder, extrapyramidal symptom, dry mouth, and fatigue showed no significant differences in the adjunctive aripiprazole treatment group compared with the placebo group (risk difference (Mantel-Haenszel [ncbi.nlm.nih.gov]

  We ask about general symptoms (anxious mood, depressed mood, fatigue, pain, and stress) regardless of condition. Last updated: January 31, 2019 [patientslikeme.com]

  While taking bromocriptine or cabergoline, you may have these side effects: Low blood pressure Nausea Mental fogginess Fatigue Nasal congestion Depression Constipation Dizziness Headache Fainting Side effects can be more severe at the beginning of treatment [babycenter.com]

• Overeating

  In addition, patients who received a low maintenance dose of CAB, and had a significant reduction in tumor size (over 50%) before withdrawal, were more likely to achieve success (51.5 and 49.4%, respectively). [ncbi.nlm.nih.gov]

  Compression over adjacent structures. Deleterious effects over the organism, specifically the skeleton. [intechopen.com]

  The over production of Prolactin Hormone leads to Hyperlactation and Galactorrhea. [herbpathy.com]

• Nausea

  Cabergoline (Dostinex) is also associated with side effects such as nausea and dizziness, but these effects are usually less common and less severe than with bromocriptine. [medicinenet.com]

  In the RCT, adverse drug reactions (ADRs) occurred at similar incidence rates among metformin and placebo patients, except that no significant increases in nausea, insomnia and agitation occurred which were not associated with discontinuations. [ncbi.nlm.nih.gov]

  These include medicines for: High blood pressure (such as calcium-channel blockers and methyldopa) Depression (tricyclic and SSRI antidepressants) Heartburn and gastroesphageal reflux disease Nausea and vomiting Pain (opiates—drugs derived from opium) [hormone.org]

• Vomiting

  No other secondary outcomes relevant to this review were reported; adverse effects for women (nausea, vomiting, headache, vertigo, fatigue, hypotension, arrhythmia, and psychotic symptoms) and infants (birth defects, low birthweight, and developmental [ncbi.nlm.nih.gov]

  These include medicines for: High blood pressure (such as calcium-channel blockers and methyldopa) Depression (tricyclic and SSRI antidepressants) Heartburn and gastroesphageal reflux disease Nausea and vomiting Pain (opiates—drugs derived from opium) [hormone.org]

  Medical Therapy Side effects of bromocriptine include nausea, vomiting, postural hypotension, dizziness, syncope, headache, constipation, nasal congestion. [clinicaladvisor.com]

• Visual Impairment

  Baseline prolactin levels, frequency of galactorrhea, amenorrhea, oligomenorrhea, erectile dysfunction, infertility, and visual impairment were similar between the two groups, whereas the baseline tumor volume was higher in the CAB group. [ncbi.nlm.nih.gov]

  Lab Tests/Rule-Outs Test / Monitor Hormone levels Prolactin levels may be ordered when a patient has symptoms of a prolactinoma such as: unexplained headaches, visual impairment, and/or galactorrhea. [digitalnaturopath.com]

  Most common symptoms of hyperprolactinemia: Oligomenorrhea Amenorrhea Galactorrhea Infertility Headaches Visual impairment Hypopituitarism Those at Risk for Hyperprolactinemia Hyperprolactinemia is common in women taking conventional antipsychotics that [clinicaladvisor.com]

  It is usually recommended for very large tumors, those with suprasellar and frontal extension, and visual impairment persisting after medications. [jhrsonline.org]

• Osteoporosis

  Hyperprolactinemia is a recognized cause of secondary osteoporosis, and treatment with dopamine agonists can lead to improved BMD. [ncbi.nlm.nih.gov]

  Treatment to correct hyperprolactinemia can restore your estrogen levels and help protect you from osteoporosis and heart disease later in life. [shadygrovefertility.com]

  Objectives of treatment of hyperprolactinemia  Restoration and maintenance of normal gonadal function  Restoration of normal fertility  Prevention of osteoporosis 15. Drug induced hyperprolactinemia 1. [slideshare.net]

• Nipple Discharge

  A 20-year-old man presented to a local physician because of a milky nipple discharge of 2 months' duration. He was otherwise healthy. Findings on physical examination were unremarkable except for the milky discharge from both nipples on expression. [ncbi.nlm.nih.gov]

  She denies hirsutism and acne but admits to thin milky nipple discharge upon squeezing (but not spontaneous). [mdedge.com]

  Nipple discharge. Obstet Gynecol Clin North Am 2002;29:21-9. [ PUBMED ] [ FULLTEXT ] 10. Hughes E, Collins J, Vanderkerckhove P. Bromocriptine for unexplained subfertility in women. Cochrane Database Syst Rev 2000;2:CD000044. [dx.doi.org]

  The day before her next injection, the patient complained of nipple discharge and breast tenderness, leading to a check of her prolactin level. [healio.com]

  Nipple discharge Rule out breast pathology (by history, physical examination, mammography) Galactorrhea 11. Step 1. Galactorrhea Evaluation for breast tumor     Unilateral Single duct Bloody or Serosanguineous Associated with breast mass 12. [slideshare.net]

• Loss of Libido

  Women with pathological hyperprolactinemia present with galactorrhea, loss of libido, infertility, menstrual dysfunction, and/or osteoporosis. Men generally present with loss of libido, erectile dysfunction, and/or gynecomastia. [amboss.com]

  When occurring outside of pregnancy or breastfeeding, they may include: Infertility Gallactoria (abnormal lactation) Infrequent or irregular periods Amenorrhea (disappearance of ovulation periods) Loss of libido Breast pain Painful intercourse due to [pcos.about.com]

• Psychiatric Symptoms

  However, augmentation with aripiprazole failed to demonstrate significant improvement in psychiatric symptoms compared with placebo. [journals.plos.org]

  Over the next 2 weeks, the patient reported resolution of her galactorrhea, and after 4 weeks the patient’s serum prolactin level was reduced to 1.8 ng/mL (97.5% reduction); 3 months later, she had no psychiatric symptoms. 18 Other Perspectives In the [healio.com]

• Headache

  We present two cases. (1) A 35-year-old woman suffering from chronic tension-type headache interspersed with occasional episodes of migraine without aura (as defined by the International Headache Society criteria). [ncbi.nlm.nih.gov]

• Irritability

  Hyperprolactinemia may also be a consequence of burns or irritation of the chest wall due to trauma. • Side effects to drugs.- Psychopharmacologic drugs, drugs for high blood pressure, estrogen, and dopamine receptor agonists such as metoclopramide, which [ingenes.com]

  High levels of prolactin may also indicate the following conditions: Chest wall trauma or irritation, caused by surgical scars, shingles, or other factors Hypothalamic disease (a problem with the hypothalamus, a region of the brain) Hypothyroidism (underactive [everydayhealth.com]

  Primary hypothyroidism (high thyrotropin-releasing hormone levels) Cushing’s syndrome (high cortisol levels) Acromegaly (high growth hormone levels) Chest Wall Reflex Any irritation to the chest wall may trigger the same reflexes as nipple stimulation [healthhype.com]

  […] isn’t producing enough hormones) Diseases affecting the hypothalamus (the part of the brain that controls the pituitary gland) Anorexia (an eating disorder ) Drugs that are used to treat depression, psychosis, and high blood pressure Chest injury or irritation [m.webmd.com]

• Lethargy

  Patients should consult their hormone specialists (endocrinologists) promptly if symptoms develop - particularly headaches, visual changes, nausea, vomiting, excessive thirst or urination, or extreme lethargy. [medicinenet.com]

• Amenorrhea

  In women it is usually associated with galactorrhea and secondary amenorrhea; in men it may be a factor in gynecomastia, decreased libido, and impotence. [medical-dictionary.thefreedictionary.com]

  Definition (MSH) Increased levels of PROLACTIN in the BLOOD, which may be associated with AMENORRHEA and GALACTORRHEA. [fpnotebook.com]

  Frequency United States This condition occurs in less than 1% of the general population and in 5-14% of patients presenting with secondary amenorrhea. [3] Approximately 75% of patients presenting with galactorrhea and amenorrhea have hyperprolactinemia [emedicine.com]

  Amenorrhea was the most common presenting symptom (49.5%) followed by galactorrhea (44.3%). Median initial serum prolactin level was 117 ng/mL (25.1-1,624 ng/mL). [ncbi.nlm.nih.gov]

• Oligomenorrhea

  One month later, she had oligomenorrhea and galactorrhea. We ruled out all causes of hyperprolactinemia. [ncbi.nlm.nih.gov]

• Sexual Dysfunction

  Serum prolactin level, menstrual disturbances, sexual dysfunction, psychopathologies, and quality of life were measured at weeks 0, 1, 2, 4, 6, and 8. [ncbi.nlm.nih.gov]

  dysfunction and found no difference between men and women in the prevalence of sexual dysfunction in such cases. [7] A study by Ishioka et al indicated that in men receiving antipsychotic agents, a link exists between hyperprolactinemia and an increase [emedicine.com]

• Vaginal Dryness

  dryness When occurring in men, the symptoms typically involve sexual dysfunction and/or pain associated with the formation of the prolactinoma. [pcos.about.com]

  In women: cessation of menstrual periods (amenorrhea), decreased menstrual flow (oligomenorrhea), abnormal production of breast milk when not breastfeeding (galactorrhea), excess facial hair (hirsutism), vaginal dryness and pain during intercourse and [healthcommunities.com]

  In addition, women may have: Vaginal dryness, leading to pain during intercourse Problems with menstruation—having no periods or irregular periods Production of breast milk when not pregnant or nursing Men may also have: Erectile dysfunction—trouble getting [hormone.org]

• Secondary Amenorrhea

  In women it is usually associated with galactorrhea and secondary amenorrhea; in men it may be a factor in gynecomastia, decreased libido, and impotence. [medical-dictionary.thefreedictionary.com]

  Frequency United States This condition occurs in less than 1% of the general population and in 5-14% of patients presenting with secondary amenorrhea. [3] Approximately 75% of patients presenting with galactorrhea and amenorrhea have hyperprolactinemia [emedicine.com]

  Methods: We retrospectively evaluated our outpatient admission records for PCOS, hirsutism, oligomenorrhea, or secondary amenorrhea. PCOS diagnosis was made after excluding other causes of hirsutismus and in accordance with Rotterdam criteria. [endocrine-abstracts.org]

In eight (5.5%) patients with MaPRL, only one had pituitary microadenoma on radiological workup. [ncbi.nlm.nih.gov]

A pregnancy history should be taken before further workup to rule out pregnancy-related galactorrhea. [aafp.org]

• Hyperprolactinemia

  /hy·per·pro·lac·tin·emia/ ( -pro-lak″tĭ-ne´me-ah ) increased levels of prolactin in the blood, often associated with pituitary adenoma.hyperprolactine´mic hyperprolactinemia (hī′pər-prō-lăk′tə-nē′mē-ə) n. [medical-dictionary.thefreedictionary.com]

  [Disease/Finding], Hyperprolactinaemia, Idiopathic hyperprolactinemia, Hyperprolactinaemia (disorder), Idiopathic hyperprolactinemia (disorder), HYPERPROLACTINEMIA, HPRL, Hyperprolactinemia (disorder), Hyperprolactinaemia, NOS, Hyperprolactinemia, NOS [fpnotebook.com]

  ETIOLOGY Hyperprolactinemia can be physiological or pathological. Some of the common causes are listed in Figure 1. Etiology of hyperprolactinemia[ 11 ] Physiological hyperprolactinemia is usually mild or moderate. [ncbi.nlm.nih.gov]

  […] with idiopathic hyperprolactinemia. [emedicine.com]

• Prolactin Increased

  The level of Prolactin increases in the Blood than the normal level. This leads to Hyperlactation, Menstrual Problems and Galactorrhea. [herbpathy.com]

  […] are pregnancy and the use of drugs that increase prolactin secretion. [ingenes.com]

  This increase starts around the 8 th week in a simultaneous way with the estrogen increasing. [intechopen.com]

CAB treatment was tolerated better than quinagolide treatment in 12 out of 39 patients (30.7%). [doi.org]

[…] recurrence, and pregnancy after treatment. [ncbi.nlm.nih.gov]

Prognosis and outcome Prognosis of Management Options Observation Patients who select observation can be counseled that up to 95% of microadenomas remain stable over time. [clinicaladvisor.com]

No evidence is yet available of the potential impact of this information on disease management and prognosis. These sophisticated tests are only available at some centers. [elsevier.es]

Patients opting for this approach had often failed other management options and may have had a worse prognosis that was independent of the treatment; this selection bias may underestimate the effectiveness of surgery. [systematicreviewsjournal.biomedcentral.com]

It is sometimes difficult to differentiate the etiology of hyperprolactinemia from a clinical perspective. Identification of the etiology of hyperprolactinemia requires a careful review of the causes and appropriate work-up. [ncbi.nlm.nih.gov]

Relatively common etiologies include PROLACTINOMA, medication effect, KIDNEY FAILURE, granulomatous diseases of the PITUITARY GLAND, and disorders which interfere with the hypothalamic inhibition of prolactin release. [fpnotebook.com]

Epidemiology References: [1] [2] Epidemiological data refers to the US, unless otherwise specified. [amboss.com]

Epidemiology Prevalence Predominant age: reproductive age Predominant sex: female > male More readily detected in females because a slight elevation in prolactin causes changes in menstruation and galactorrhea Etiology and Pathophysiology Prolactin, which [unboundmedicine.com]

Women with naturally higher prolactin levels have higher risk of breast cancer according to a large epidemiologic study. [rainbow.coop]

Epidemiologic features An excess of prolactin above a reference laboratory's upper limits, or “biochemical hyperprolactinemia,” can be identified in up to 10% of the population. 1 Women with oligomenorrhea, amenorrhea, galactorrhea or infertility, and [cmaj.ca]

Epidemiology and etiopathogenesis of pituitary adenomas. Journal of Neuro-Oncology. 2014;117(3):379-94. Melmed S. Pituitary Tumors. Endocrinol Metab Clin N Am. 2015;44:1-9. Tong Y, Zheng Y, Zhou J, Oyesiku NM, Koeffler HP. [medigraphic.com]

Dopamine is the most important prolactin-inhibiting factor, and dopaminergic hyperactivity has been implicated in the pathophysiology of psychosis. [ncbi.nlm.nih.gov]

In Reproductive Endocrinology: Physiology, Pathophysiology and Clinical Management, edited by SSC Yen and RB Jaffe. Philadelphia, WB Saunders Company, 1978, p. 493. [msdmanuals.com]

SELECTION CRITERIA: Randomized controlled trials (RCTs) in all languages examining the effect of dopamine agonists on preventing future miscarriage. [ncbi.nlm.nih.gov]