ContentsSynopsisCodesLook ForDiagnostic PearlsDifferential Diagnosis & PitfallsBest TestsManagement PearlsTherapyDrug Reaction DataReferencesView all Images (2)
Hyperprolactinemia
Print
Other Resources UpToDate PubMed

Hyperprolactinemia

Print Images (2)
Contributors: Abigail Clarkson-During BA, Marilyn Augustine MD, Abhijeet Waghray MD
Other Resources UpToDate PubMed

Synopsis

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.

For more information, see OMIM.

Codes

ICD10CM:
E22.1 – Hyperprolactinemia

SNOMEDCT:
237662005  – Hyperprolactinemia

Look For

Subscription Required

Diagnostic Pearls

Subscription Required

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

Subscription Required

Management Pearls

Subscription Required

Therapy

Subscription Required

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.

Subscription Required

References

Subscription Required

Last Reviewed: 07/02/2019
Last Updated: 07/03/2019
Copyright © 2019 VisualDx®. All rights reserved.
Hyperprolactinemia
Print 2 Images
View all Images (2)
(with subscription)
Hyperprolactinemia (Female) : Amenorrhea, Infertility, Galactorrhea, Oligomenorrhea, Vaginal dryness, Decreased libido
Copyright © 2019 VisualDx®. All rights reserved.