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

  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]

  They typically present with oligomenorrhea, amenorrhea, galactorrhea, or infertility. Galactorrhea is less common in postmenopausal women due to lack of estrogen. [emedicine.com]

• Weight Gain

  A 38-year-old white female patient seeks medical attention complaining of weight gain (Body mass index: 35) associated with anxiety. She started sibutramine treatment and presented with amenogalactorrhea. [ncbi.nlm.nih.gov]

  The principal concern for endocrinologists with the newer drugs has been the metabolic effects of weight gain, glucose intolerance, hyperlipidemia, and hypertension [ 2 ]. [ijpeonline.biomedcentral.com]

  Moreover, hyperprolactinemia has been linked to weight gain and insulin resistance, which can be ameliorated following medical treatment. [link.springer.com]

• Heat Intolerance

  Moreover, as majority of population were females, the clinical features in the macroprolactinemia group as compared to true hyperprolactinemic group were mostly related to non-pituitary causes like drug intake [42.5% (54) vs. 37% (30)], heat intolerance [ncbi.nlm.nih.gov]

• 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 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]

  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]

  There are, however, gender-specific symptoms… Symptoms of Hyperprolactinemia For Women : irregular nipple discharge breast milk production in the absence of pregnancy (Galactorrhea) irregular menstrual cycles including amenorrhea (absent period) and luteal [natural-fertility-info.com]

• 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]

• 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]

• Frontal Headache

  After 6 months, however, she complained of persistent frontal headache and a repeat MRI revealed that the adenoma had increased in size to 16 mm. The patient was referred to an endocrinologist for further evaluation. [ncbi.nlm.nih.gov]

• Amenorrhea

  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]

  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]

  J Hum Reprod Sci 2010;3:111-2 Amenorrhea with infertility has long been challenging to the treating physician. A high prolactin level is encountered in about one- third of women with no obvious cause of amenorrhea. [dx.doi.org]

• 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

  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]

  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]

  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]

• Prolactin Increased

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

  In a limited number of cases where prolactin increase is caused by pituitary tumors larger than 10 mm that do not improve with drugs, the possibility of performing a surgery or radiation treatment must be evaluated. [ingenes.com]

  Kruger TH et al have demonstrated that sexual intercourse with orgasm induced not only the well-established immediate prolactin increasing of 300% but also an additional prolactin elevation around noon of the next day. [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]

Use Additional Use Additional Help Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10data.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 Hyperplolactinemia is a common endocrine disorder, occurring in 15% to 20% of women with menstrual disturbances [ 1–3 ], 43% to 87% of women with both amenorrhea and galactorrhea [ 1,2 ], and 30% to 40% of infertile women [ 4,5 ]. [journals.lww.com]

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

References: [1] [2] [3] [4] Pathophysiology Clinical features Patients with hyperprolactinemia due to a pituitary adenoma may also present with bitemporal hemianopsia and headache (see section on “Clinical features of pituitary adenomas ”) References: [amboss.com]

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