What is Hyperprolactinemia?
Hyperprolactinemia is a condition in which the amount of prolactin in blood increases and the excessive presence of this hormone; which is responsible for the production of milk in breasts of women, cause various problems in both men and women.
Hyperprolactinemia is caused by prolactin which is a peptide hormone. This basically means that it is a protein made from amino acids chain and is responsible for the enlargement of breasts of women during pregnancy and production of milk in them
Normal level of prolactin for women is -450mlU/L while for men it is- 500mlU/L
If the level of prolactin increases above the normal level, it results into a condition that is termed as Hyperprolactinemia.
Symptoms of Hyperprolactinemia
Symptoms of hyperprolactinemia for men and women are not same. Instead they exhibit different symptoms and they are as follows:
Symptoms of Hyperprolactinemia in Women
For women hyperprolactinemia symptoms include:
Those women who are suffering from hyperprolactinemia, experience a decrease in menstruation flow and sometimes, it stops altogether. This stopping of menstruation is known as amenorrhoea and can be a symptom of hyperprolactinemia. In some women, menstruation cycle becomes irregular due to hypoestrogenism. Hypoestrogenism in women is decreased production of estrogen hormone which is a result of hyperprolactinemia.
Hyperprolactinemia also causes infertility in women. This infertility in women is due to decreased production of estrogen or hypoestrogenism which, as described above, happens due to hyperprolactinemia. Thus infertility is also one of the symptoms of hyperprolactinemia.
Hyperprolactinemia symptoms can also include production of breast milk in women who are neither pregnant nor nursing. Women who are suffering from hyperprolactinemia may also experience pain in their breasts especially when their prolactin level increases for the first time.
Decreased interest in sex is also one of the symptoms of hyperprolactinemia. Apart from decreased libido, women may also experience pain during coitus or sex due to dry vagina as vaginal secretions are reduced in hyperprolactinemia.
Symptoms of Hyperprolactinemia in Men
Symptoms of hyperprolactinemia for men include following conditions:
One of the symptoms of hyperprolactinemia is erectile dysfunction or impotency which is the inability to maintain erection of penis during sexual intercourse.
Infertility in men usually due to low sperm count in their semen is also one of the symptoms of hyperprolactinemia.
Breast enlargement in men is known as gynecomastia. In this symptom of hyperprolactinemia breasts of men get enlarged just like women.
Since men do not have such a handy indicator as menstruation, they usually do not consult a doctor even if they have some of the symptoms of hyperprolactinemia due to pituitary enlargement. They get to know about their problem only when they start experiencing headaches and eye problems due to enlarged pituitary putting pressure on the optic chasm. So, eye problems and headaches caused by pituitary enlargement are also a symptom of hyperprolactinemia.
Just like in women, men also experience decreased libido which is a symptom of hyperprolactinemia. But this symptom usually goes unnoticed.
Hypoestrogenism and hypoandrogenism can also cause osteoporosis in people suffering from hyperprolactinemia.
Causes of Hyperprolactinemia
Hyperprolactinemia can be caused by a variety of reasons including disinhibition i.e. compression of pituitary stalk or reduced dopamine levels or due to a type of pituitary tumor or adenoma known as prolactinoma. If the level of prolactin is above 200µg/L, then it is most likely because of a tumor.
Some of the causes of hyperprolactinemia include:
Physiological Causes of Hyperprolactinemia
Physiological causes of hyperprolactinemia include following things:
When the females are pregnant, the level of prolactin in their body increases. This is because the body is preparing itself for nursing the child. The level of prolactin is highest at the time of the delivery.
Breast feeding or nursing females produce a lot of prolactin. The more the breasts are stimulated, the more prolactin is produced.
When the person is under a lot of mental stress, it can lead to hyperprolactinemia due to excess production of prolactin in the body. This is because stress affects hypothalamus as well as pituitary gland which are directly involved in the production of prolactin.
Pathological Causes of Hyperprolactinemia
Pathological causes of hyperprolactinemia include:
Prolactinoma or some other pituitary adenomas can result into hyperprolactinemia. This is because these tumors block the flow of dopamine. Dopamine is a chemical that is released by the brain and when it reaches prolactin secreting cells, it inhibits the production of prolactin. Therefore, when these tumors block dopamine it results into hyperprolactinemia.
In acromegaly, which is a growth disorder resulting into uncontrolled growth due to the excess production of growth hormone. This also works by suppression of dopamine and therefore can also cause hyperprolactinemia.
After epileptic seizures, prolactin levels rises drastically. That is actually how doctors sometimes distinguish epileptic seizures from non-epileptic ones. So, in a way they also cause hyperprolactinemia.
Drug Related Causes of Hyperprolactinemia
Apart from these causes, some drugs can also cause hyperprolactinemia. Those drugs that cause less production of dopamine or inhibit its function or deplete its stores in brain can cause hyperprolactinemia as well. Some of these drugs include tranquillizers, antipsychotics and even some of those drugs that are used to control hypertension.
Other Causes of Hyperprolactinemia
Apart from these causes hyperprolactinemia can also be caused by hypothyroidism. Women suffering from PCOS (Polycystic Ovarian Syndrome) may also have slightly higher level of prolactin than normal. Other diseases that result into hyperprolactinemia are chronic renal failure, carcinomas, granulomas and sarcoidosis etc.
Diagnosis of Hyperprolactinemia
Preliminary diagnosis of hyperprolactinemia occurs by symptoms only. A doctor usually uses one of the following methods to diagnose for hyperprolactinemia:
Diagnosis through Symptoms and Testing
Irregular menstrual cycle, infertility and unexpected milk production in woman indicates hyperprolactinemia while in men it can be indicated by the growth of breasts and sexual dysfunction. So if any of these conditions occur, doctors prescribe a test for prolactin levels. If the level of prolactin is found to be quite high, then the doctor will test for the level of thyroid hormones. He will also ask the patients some questions about the use of any medication that is known to increase the level of prolactin causing hyperprolactinemia.
Diagnosis through X-Ray
If hyperprolactinemia is due to a tumor or the presence of an adenoma is suspected, then X-ray is performed. If the adenoma or tumor is large enough, it can be detected with the help of X-ray.
Diagnosis through MRI
Even though, if a tumor causing hyperprolactinemia is big enough, its presence can be detected through X-ray; the most sensitive technique to detect it is MRI or Magnetic Resonance Imaging. It can not only detect the presence of a very small adenoma but can also determine its size. Not only this, but it can also be used to monitor the growth of the tumor that is causing hyperprolactinemia.
Treatment of Hyperprolactinemia
Treatment of hyperprolactinemia usually involves the use of drugs but sometimes surgery can also be done.
Treatment by Using Medications
Treatment of hyperprolactinemia can be done by using medications that contain dopamine agonists or compounds that activate dopamine receptors. Some of these medications are cabergoline, bromocriptine and lisuride etc.
Treatment by Surgery
Sometimes if the tumor has progressed quite far, surgery can also be done to remove those tumors. Surgery can also be used if the medicine proves to be ineffective in treating hyperprolactinemia. It can also be used if tumor is affecting the vision of the patient quite severely.
So these are the methods used to detect and cure hyperprolactinemia.
- Mayo Clinic – Hyperprolactinemia: https://www.mayoclinic.org/diseases-conditions/hyperprolactinemia/symptoms-causes/syc-20352677
- Endocrine Society – Hyperprolactinemia: https://www.hormone.org/diseases-and-conditions/hyperprolactinemia
- Cleveland Clinic – Hyperprolactinemia: https://my.clevelandclinic.org/health/diseases/17202-hyperprolactinemia
- American Association of Clinical Endocrinologists (AACE) – Hyperprolactinemia: https://www.aace.com/disease-state-resources/hyperprolactinemia
- Medscape – Hyperprolactinemia and Prolactinoma: https://emedicine.medscape.com/article/122287-overview
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) – Prolactinoma: https://www.niddk.nih.gov/health-information/endocrine-diseases/prolactinoma
- American Journal of Obstetrics and Gynecology – Hyperprolactinemia and Female Infertility: https://www.ajog.org/article/S0002-9378(14)01147-8/fulltext
- Endotext – Hyperprolactinemia: https://www.endotext.org/chapter/hyperprolactinemia/