Introduction

Hyperprolactinemia is a condition of elevated prolactin level in blood 

-Prolactin is a pituitary hormone which acts to induce and maintain lactation and to decrease reproductive function and libido via via suppression of gonadotropin-releasing hormone [GnRH]

-Dopamine suppresses the production of prolactin from the anterior pituitary, so dopamine antagonists are associated with hyperprolactinemia

-The most common cause of hyperprolactinemia is a prolactin-secreting pituitary adenoma. Other causes are hypothyroidism, hypothalamic masses, 

and medications (risperidone, haloperidol, chlorpromazine, perphenazine, SSRIs, metoclopramide, opiates, H2 antagonists)

Symptoms & Signs

Men: Erectile dysfunction, loss of libido, gynecomastia, headaches, visual symptoms 

Women: loss of libido, amenorrhea, oligomenorrhea, infertility, irritability, anxiety, depression, galactorrhea and osteoporosis  

Diagnosis 

Labs: Fasting prolactin levels; labs to rule out other conditions such as hypothyroidism, pregnancy 

Imaging: Pituitary MRI

Treatment 

Dopamine agonists: Primary treatment of hyperprolactinemia; cabergoline, bromocriptine, or quinagolide

-Cabergoline is the preferred drug for the treatment of hyperprolactinemia because of greater efficacy and lower adverse effects

-Cabergoline can cause valvular heart disease 

Levothyroxine: if hypothyroidism is the cause of hyperprolactinemia 

Surgery: Transsphenoidal pituitary surgery for adenomas which are resistant to medical therapy