Hyperprolactinemia is a condition when the level of the hormone prolactin in the blood is higher than normal. This condition can cause problems with sexual and reproductive function.
Prolactin is produced by the pituitary gland (pituitary) which is at the base of the brain. The function of prolactin for the body is very broad, starting from the regulation of the reproductive system, metabolism, to the immune system. In women, this hormone plays a major role in increasing milk production after childbirth.
An increase in prolactin is normal during pregnancy or breastfeeding. However, if it occurs outside of these two conditions, hyperprolactinemia needs to be found and treated for the cause.
Causes of Hyperprolactinemia
Hyperprolactinemia can occur as a result of certain diseases or the use of certain medications. The following are some diseases or conditions that can cause hyperprolactinemia:
- Prolactinoma (benign tumor of the pituitary gland)
- Tumors or other diseases affecting the pituitary gland
- Infection, tumor, or injury to the hypothalamus
- Cushing's syndrome
- Hypothyroidism (lack of thyroid hormone)
- Cirrhosis
- Chronic kidney failure
- Injury to the chest wall or other conditions affecting the chest wall, eg herpes zoster
- Acromegaly
Meanwhile, drugs that can cause hyperprolactinoma include:
- H2 acid blockers, such as cimetidine and ranitidine
- Antihypertensives, such as verapamil, nifedipine, and methyldopa
- Estrogen, for example in birth control pills or hormone replacement therapy
- Antidepressants, such as fluoxetine, amitriptyline, and citalopram
- Antipsychotics, risperidone and haloperidol
- Nausea and vomiting relievers, such as metoclopramide and domperidone
- Pain relievers or opioids
- Family planning pills
Hyperprolactinemia is most often caused by a prolactinoma. This condition is more common in women than men and very rarely affects children.
In some cases, hyperprolactinemia can occur without a known cause. This condition is known as idiopathic hyperprolactinemia.
Symptoms of Hyperprolactinemia
Symptoms of hyperprolactinemia can occur when the level of the hormone prolactin in the blood is higher than it should be. Normally, the level of the hormone prolactin in the blood is:
- Men: 2–18 nanograms/milliliter (ng/mL)
- Non-pregnant women: 2–29 ng/mL
- Pregnant women: 10–209 ng/mL
Symptoms that arise due to hyperprolactinemia can be different in each patient. However, there are common symptoms that can be experienced by sufferers both men and women, including:
- Difficulty having children
- Decreased sexual desire
- Bone loss
- Narrowing of the field of view
- Discharge of milk or milk-like fluid from the nipples that is not related to pregnancy (galactorrhea)
Especially in women, symptoms of hyperprolactinemia that can appear include:
- Irregular menstruation or stopping altogether
- Vagina becomes dry, causing pain during sexual intercourse
- Pain in the breast
- Delayed puberty in adolescents
Meanwhile, the symptoms of hyperprolactinemia in men can include:
- Impotence or erectile dysfunction
- Headache
- Decreased muscle mass and body hair
- Breast enlargement (gynecomastia)
- Decreased sperm count
When to go to the doctor
Check with your doctor if you experience the symptoms of hyperprolactinemia as mentioned above, especially if you have the following symptoms:
- Galactorrhea
- Erectile dysfunction
- Decreased sexual desire
- Narrowing of the field of view
Diagnosis of hyperprolactinemia
Doctors can suspect a patient has hyperprolactinemia based on the symptoms experienced, medical history, and patient's medical history. The doctor will also do a pregnancy test to make sure the patient is not pregnant, except in patients who have gone through menopause or have had a hysterectomy.
To establish a diagnosis, the doctor will order blood tests to measure levels of the hormone prolactin. If the levels are high, thyroid hormone levels and kidney function tests will be done to find out the cause of the hyperprolactinemia.
If the patient's prolactin level is very high (> 250 ng/mL), there is a possibility that the hyperprolactinemia is caused by a prolactinoma. To confirm this, an MRI scan of the brain and pituitary gland is necessary.
Treatment of hyperprolactinemia
Treatment of hyperprolactinemia aims to return prolactin levels back to normal. The method of treatment will be tailored to the patient's condition, age, and medical history, as well as the cause of hyperprolactinemia.
In hyperprolactinemia caused by tumors, treatment can include:
- Administration of drugs, such as bromocriptine and cabergoline, to reduce the production of the hormone prolactin and reduce pituitary tumors
- Surgical removal of the tumor, if the use of drugs does not work or causes allergies in the patient
- Radiation therapy to shrink tumors, only when drugs and surgical procedures are ineffective
If the examination also found hypothyroidism, the doctor will correct the hypothyroid condition by giving synthetic thyroid hormone. After that, generally prolactin hormone levels will be normal.
In hyperprolactinemia caused by the consumption of drugs, the doctor will adjust the dose or change the drug, so that prolactin hormone levels return to normal.
Hyperprolactinoma complications
Complications of hyperprolactinemia usually occur in hyperprolactinemia caused by prolactinoma. Complications that can occur depending on the size of the tumor and disorders due to high prolactin levels, include:
- Blindness
- Bleeding (hemorrhagic stroke)
- Fractures due to osteoporosis
- Infertility
