Hyperprolactinemia occurs when there are elevated levels of the hormone prolactin in your bloodstream. This condition can lead to several noticeable health issues, including irregular menstrual cycles in women and unexpected breast milk production.
Commonly referred to simply as high prolactin, this condition is typically diagnosed when levels exceed 25 ng/mL. Various factors can trigger this increase, such as pregnancy, polycystic ovary syndrome (PCOS), or an underactive thyroid.
If you notice signs of high prolactin, you should consult an endocrinologist or a gynecologist for a full evaluation. Proper treatment often involves medication, though more complex cases may occasionally require surgical intervention.
Main symptoms
The most common symptoms associated with hyperprolactinemia include:
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Irregular periods or a complete absence of menstruation.
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A noticeable decrease in sexual desire.
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Difficulty conceiving or infertility.
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Galactorrhea, which is the spontaneous flow of milk from the breasts.
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Loss of bone density, known as osteoporosis.
Depending on what is causing the hormone spike, some individuals may also experience frequent headaches or changes in their vision, such as blurriness or seeing double.
Symptoms in men
In men, hyperprolactinemia typically presents as erectile dysfunction or a lower libido. It can also lead to male infertility and gynecomastia, which is the enlargement of breast tissue.
Confirming a diagnosis
To confirm a diagnosis, an endocrinologist or gynecologist will perform a physical exam and review your full medical history. They will primarily look for the specific physical signs and symptoms mentioned above.
The most critical step in the diagnostic process is a blood test to measure the exact concentration of prolactin in your system.
According to the Endocrine Society, a single measurement of serum prolactin above the upper limit of normal is sufficient to confirm a diagnosis of hyperprolactinemia, provided the blood sample was obtained without excessive venipuncture stress.
Your doctor may also order a pregnancy test or blood work to check your kidney and liver function, such as creatinine, AST, and ALT levels. Additionally, imaging tests like an MRI or CT scan may be used to rule out conditions like thyroid issues, cirrhosis, or pituitary tumors.
High prolactin levels
A diagnosis of hyperprolactinemia is generally made when blood prolactin levels rise above 25 ng/mL.
If levels are found to be significantly higher, specifically above 250 ng/mL, it often suggests the presence of a prolactinoma. This is a noncancerous tumor located in the pituitary gland, which is the gland responsible for secreting the hormone.
Possible causes
There are several biological and lifestyle factors that can cause prolactin levels to rise:
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Pregnancy and breastfeeding.
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High levels of physical or emotional stress.
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Intense physical activity.
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Pituitary tumors (prolactinomas).
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Primary hypothyroidism.
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Kidney or liver disease.
Certain medications can also trigger hyperprolactinemia. These include antipsychotics like risperidone; antidepressants like fluoxetine; blood pressure medications like verapamil or methyldopa; and certain gastrointestinal drugs. Hormonal contraceptives containing estrogen are also common causes.
Treatment options
Treatment for hyperprolactinemia is tailored to the underlying cause and may involve medication, surgery, or radiation therapy.
1. Medications
If a specific drug is causing the hormone increase, your doctor may suggest stopping that medication or switching to an alternative.
Based on clinical practice guidelines from the Endocrine Society, cabergoline is the preferred first-line treatment for patients with prolactinomas because it is more effective than other dopamine agonists in normalizing prolactin levels and reducing tumor size.
Bromocriptine is another effective option, though it is often used as a second choice if cabergoline is not tolerated.
2. Surgery
Surgery, such as a transsphenoidal procedure or craniotomy, is reserved for large tumors that do not respond well to medication. It is also considered if the tumor is pressing on the optic nerves and causing vision loss.
In rare cases, surgery is necessary if a patient cannot tolerate the side effects of medication or if there is a leak of cerebrospinal fluid into the nasal cavity.
3. Radiation therapy
Radiation is generally used as a last resort. It is typically only recommended for tumors that have not responded to both medication and surgical efforts.
Common questions about hyperprolactinemia
1. Is hyperprolactinemia a serious condition?
In most cases, hyperprolactinemia is not considered life threatening. The clinical outlook depends entirely on the root cause and how well the body responds to treatment.
2. Does high prolactin cause weight gain?
Hyperprolactinemia may contribute to weight gain in some people. Research suggests that high prolactin levels can increase appetite and lead to insulin or leptin resistance. However, more clinical studies are needed to definitively prove a direct link between the condition and weight changes.