Hyperprolactinemia is a condition of elevated serum prolactin.
Presentation
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]
Entire Body System
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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]
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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]
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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]
Breast
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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]
Psychiatrical
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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]
Neurologic
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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]
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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]
Urogenital
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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]
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Oligomenorrhea
One month later, she had oligomenorrhea and galactorrhea. We ruled out all causes of hyperprolactinemia. [ncbi.nlm.nih.gov]
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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]
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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]
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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]
Workup
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]
Serum
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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]
Treatment
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
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]
Etiology
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
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]
Pathophysiology
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]
Prevention
SELECTION CRITERIA: Randomized controlled trials (RCTs) in all languages examining the effect of dopamine agonists on preventing future miscarriage. [ncbi.nlm.nih.gov]