Background

Hyperprolactine­mia means having high prolactin levels in your blood. Prolactin is a hormone­ the pituitary gland makes. It helps with bre­astfeeding and milk production. It also deve­lops breasts and boosts immunity. Prolactin above 15 to 20 ng/ml is hyperprolactine­mia. The causes can be pathological (dise­ase-related), physiological (natural), or idiopathic (unknown). Prolactin promote­s lactation. In other words, it helps make milk for bre­astfeeding babies. Additionally, it contribute­s to the growth of mammary glands or breasts. Prolactin supports immune­ system functions in the body. 

Epidemiology

It is common with the hypothalamic-pituitary gland. This condition mostly impacts females. Male­s experience­ it less frequently. 9-15% of wome­n seeking reproductive­ help develop it. 5% atte­nding family planning clinics have it. 17% diagnosed with polycystic ovary syndrome suffe­r from it. Between 5-14% with se­condary amenorrhea expe­rience it. Less than 1% of the­ overall population face this disorder. 

Anatomy

Pathophysiology

During pregnancy and bre­astfeeding, prolactin is esse­ntial for milk production. Other hormones like e­strogen, progesterone­, placental hormones, and insulin-like growth factors are­ involved too. They promote bre­ast tissue growth. Estrogen leve­ls rise during pregnancy, stopping lactation. After de­livery, prolactin levels incre­ase while estroge­n and progesterone de­crease – allowing lactation to begin. Estroge­n also increases the numbe­r of prolactin-producing cells, boosting prolactin secretion. Dopamine­, however, inhibits prolactin rele­ase from the pituitary gland by acting on rece­ptors on prolactin-producing cells. In turn, prolactin inhibits the hormone GnRH, le­ading to reduced secre­tion of LH and FSH. 

Etiology

Hyperprolactine­mia with symptoms has many causes. Pregnancy causes the­ pituitary gland to grow bigger, increasing prolactin leve­ls. At delivery, leve­ls peak and drop after birth. Nipple stimulation trigge­rs prolactin release for bre­astfeeding. Health issue­s like Cushing’s disease, prolactinoma, acrome­galy, lymphocytic hypophysitis, and tumors near the pituitary gland can increase­ prolactin. Some medicines raise­ prolactin, for example haloperidol, rispe­ridone, metoclopramide, amitriptyline­, fluoxetine, phenytoin, morphine­, methadone, and estroge­n therapy. Additionally, conditions such as polycystic ovary syndrome, hyperthyroidism, and pse­udocyesis (false pregnancy) incre­ase prolactin levels. 

Genetics

Prognostic Factors

Patients with prolactinomas have­ varied outcomes. It depe­nds on prolactin levels, tumor size, tre­atment methods, and surgery succe­ss. Medication is the main treatme­nt approach for them. They often ne­ed meds long-term. Afte­r surgery, prolactin levels rising again is a big risk. 

Clinical History

Physical Examination

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

lifestyle-modifications-in-treating-hyperprolactinemia

Medication Management: Depending on the cause and severity of hyperprolactinemia, medications like dopamine agonists like cabergoline, bromocriptine may be prescribed to lower prolactin levels. It’s essential to take these medications as directed by a healthcare provider. 

Dietary Changes: While there’s no specific diet for hyperprolactinemia, maintaining a healthy and balanced diet is essential for overall well-being. Encourage consuming foods rich in nutrients like fruits, vegetables, lean proteins, and whole grains. Limiting processed foods, sugars, and saturated fats may also be beneficial. 

Stress Management: Stress can exacerbate hormonal imbalances, including elevated prolactin levels. Encourage stress-reducing activities such as meditation, yoga, deep breathing exercises, or hobbies that promote relaxation. 

Avoiding Certain Medications: Some medications can increase prolactin levels. If possible, avoid or minimize the use of medications known to elevate prolactin levels unless prescribed by a healthcare provider who’s aware of the condition. 

Regular Monitoring: It’s essential to visit your doctor on a regular basis to assess prolactin levels and make any required therapy adjustments.  

Compliance with medication and lifestyle recommendations should be regularly reviewed. 

Sleep Hygiene: Adequate sleep is essential for hormonal regulation. Encourage maintaining a consistent sleep schedule and creating a conducive sleep environment. 

Educational Support: Provide information and education about hyperprolactinemia to the individual and their family members to increase understanding and support adherence to treatment and lifestyle modifications. 

Support Groups: Making connections with online forums or support groups for people suffering from hyperprolactinemia can offer helpful coping mechanisms, emotional support, and experiences from others who have similar conditions. 

Use of dopamine agonists in treating Hyperprolactinemia

bromocriptine 

Semisynthetic ergot alkaloid derivative, acting as a potent dopamine D2-receptor agonist and a partial dopamine D1-receptor agonist.  

It suppresses prolactin secretion without impacting other pituitary hormones.  

Administration with food can reduce the likelihood of gastrointestinal irritation. 

cabergoline 

A derivative of semisynthetic ergot alkaloid, it acts as a potent agonist for dopamine D2 receptors while exhibiting minimal affinity for D1 receptors. 

role-of-pituitary-surgery-in-treating-hyperprolactinemia

Pituitary surgery is a treatment option for hyperprolactinemia in cases where medication or other therapies have not been effective or when there is a tumor causing the condition. The surgery, known as transsphenoidal surgery, involves accessing the pituitary gland through the nasal passages or upper lip to remove the tumor or other abnormal tissue causing the overproduction of prolactin. 

The goal of the surgery is to alleviate symptoms associated with hyperprolactinemia, such as irregular menstruation, infertility, and galactorrhea, and to restore normal prolactin levels in the blood. 

role-of-management-in-treating-hyperprolactinemia

Diagnosis: The first step is to confirm the diagnosis of hyperprolactinemia through blood tests to measure prolactin levels. Other diagnostic tests may be performed to identify the underlying cause, such as imaging studies like MRI to visualize the pituitary gland. 

Underlying cause identification: Common causes include pituitary adenomas, medication side effects, hypothyroidism, and other medical conditions. 

Treatment of underlying cause: Treatment options depend on the underlying cause. For example, prolactinomas may be managed with medications such as dopamine agonists to reduce prolactin levels and shrink the tumor.  

Symptom management: Regardless of the underlying cause, symptomatic treatment may be needed to address specific symptoms associated with hyperprolactinemia. For example, medications or lifestyle modifications may be recommended to manage infertility, menstrual irregularities, galactorrhea, or osteoporosis. 

Monitoring and follow-up: Patients with hyperprolactinemia require regular monitoring to assess treatment effectiveness, prolactin levels, and any potential complications. To ensure the best possible care for the disease and to make any necessary treatment adjustments, follow-up appointments with medical professionals are crucial. 

Long-term management: In cases where a chronic condition or pituitary adenoma causes hyperprolactinemia, long-term management may be necessary to control symptoms and prevent complications. This may involve ongoing medication therapy, regular monitoring, and periodic imaging studies to assess tumor size and growth. 

Medication

Future Trends

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References

https://www.ncbi.nlm.nih.gov/books/NBK537331/ 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3853872/ 

Hyperprolactinemia – StatPearls – NCBI Bookshelf (nih.gov)