Hyperprolactinemia is an abnormally high level of prolactin in the blood due to hypersecretion of prolactin from lactotroph cells in the pituitary gland due to physiologic or pathologic causes. There is a predisposition in women. This hypersecretion may result from a prolactin-secreting tumor (prolactinoma), pregnancy, medications (typically antipsychotic drugs or other medications that inhibit dopamine), or a large pituitary tumor.
Clinical presentation is variable. Female patients most commonly present with oligomenorrhea, amenorrhea, reduced libido, or infertility (resulting from prolactin suppression of gonadotropin-releasing hormone [GnRH]). Galactorrhea in females may occur as a result of the physiologic effect of prolactin on breast epithelial cells. Male patients most commonly present with loss of libido, visual impairments, or headache. Decreased serum testosterone levels and hypogonadism in males may occur due to a decrease in luteinizing hormone (LH) and follicle-stimulating hormone (FSH) resulting from prolactin suppression of GnRH. In both male and female patients, a pituitary tumor may cause visual-field defects and headache.
Complications include osteoporosis, which may result from decreased gonadal steroid secretion.
Hyperprolactinemia
Alerts and Notices
Synopsis
Codes
ICD10CM:
E22.1 – Hyperprolactinemia
SNOMEDCT:
237662005 – Hyperprolactinemia
E22.1 – Hyperprolactinemia
SNOMEDCT:
237662005 – Hyperprolactinemia
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Pregnancy or breastfeeding can result in physiologically normal elevated prolactin levels.
- Macroprolactin can result in elevated prolactin levels without any clinical abnormality. The laboratory can precipitate macroprolactin prior to analysis for prolactin to avoid misdiagnosis.
- Chronic renal failure can result in decreased clearance of prolactin and increased secretion of prolactin.
- Chest wall injuries or nipple stimulation can transiently increase prolactin levels.
- Prolactinoma (prolactin-secreting pituitary tumor)
- Medication side effect (eg, dopamine antagonists such as some antipsychotics)
- Pituitary metastases (eg, pituitary tumor)
- Primary hypothyroidism can present with mild hyperprolactinemia.
- Hyperparathyroidism
- Acromegaly
- Increased pituitary size can be a normal variant in young women.
Best Tests
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.
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References
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Last Reviewed:07/01/2019
Last Updated:01/17/2022
Last Updated:01/17/2022