Approach to Hyperprolactinemia

Clinical presentation of hyperprolactinemia

Type Clinical features 
Normal Physiology  
  • Prolactin secreted by lactotroph cells in pituitary gland 
    • Levels increase significantly during pregnancy 
    • Prolactin can also increase with physical exertion, stress, and nipple stimulation during breastfeeding 
  • Normal level ~ 20 ng/mL 
    • Hyperprolactinemia suppresses pulsatile GnRH release to cause hypogonadotropic hypogonadism 
Premenopausal women 
  • Hypogonadism due to inhibition of GnRH release  
    • Prolactin 20-50 ng/mL 
      • Infertility 
    • Prolactin 50-100 ng/mL 
      • Oligomenorrhea or amenorrhea 
      • Infertility 
    • Prolactin > 100 ng/mL 
      • Hot flashes 
      • Vaginal dryness 
      • Plus above findings 
  • Possible decrease in bone density 
  • Possible galactorrhea 
Postmenopausal women 
  • Already have underlying hypogonadal symptoms due to menopause 
  • Can have headaches or impaired vision 
Men 
  • Hypogonadism due to decreased testosterone secretion 
    • Decreased energy and libido 
    • Decreased muscle mass 
    • Hair loss 
    • Osteoporosis 
  • Erectile dysfunction 
  • Possible infertility 
  • Possible galactorrhea 
(Next Lesson) Causes of hyperprolactinemia
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