Hyperprolactinemia: Specialists and Information

Typical signs in men include

• erectile dysfunction,
• decreased libido,
• enlarged breasts, and
• a decrease in pubic hair and beard growth.

In women, hyperprolactinemia usually manifests through the following signs:

• menstrual and sexual dysfunction,
• milk production from the breasts without pregnancy,
• androgenization (“masculinization”) due to altered hormone levels: increased body hair, a deeper voice, and more acne-prone skin due to increased sebum production.

Infertility is also one of the possible consequences of hyperprolactinemia. In men, for example, sperm production is reduced due to excess prolactin. However, those affected cannot determine their own infertility; a fertility evaluation is necessary for this.

To detect and treat hyperprolactinemia, people need to monitor themselves closely. If they notice changes in their body or sexual behavior, they should consult a doctor.

There are many different causes that can lead to hyperprolactinemia.

One cause may be a benign tumor (pituitary adenoma: prolactinoma). Prolactin is produced in the anterior lobe of the pituitary gland. If a benign tumor develops in the pituitary gland, it can lead to overproduction and increased release of the hormone.

Medications can also frequently increase prolactin production. Some medications affect the action of the neurotransmitter dopamine, which acts as a regulator of prolactin. These include certain

• antipsychotics,
• antidepressants,
• estrogen,
• certain blood pressure-lowering medications,
• pain relievers containing morphine-like ingredients, and
• anti-seizure medications from the group of dopamine antagonists.

The pituitary gland produces and regulates the hormone prolactin. Disruptions can lead to excess prolactin © bilderzwerg | AdobeStock

In rare cases, an accident or fall can also cause hyperprolactinemia. An injury can damage or sever the pituitary stalk. As a result, dopamine can no longer reach the pituitary gland, and prolactin production is disrupted.

Also,

• hypothyroidism,
• kidney failure, or
• liver failure

can cause hyperprolactinemia.

If hyperprolactinemia is suspected, blood hormone levels are measured. If prolactin levels are elevated, hyperprolactinemia is present. The next step is to determine the cause of the elevated levels.

Using magnetic resonance imaging (MRI), doctors check whether

• there is a tumor in the anterior pituitary lobe or
• there are abnormalities in the pituitary stalk

are present. Corresponding tests of the

• kidney,
• liver, and
• thyroid

can reveal any dysfunction in these organs.

The doctor can identify drug-related causes by reviewing the patient’s medical records.

Once the cause of hyperprolactinemia has been identified, doctors can treat it specifically.

If a specific medication is causing the hyperprolactinemia, its dose should be reduced. Alternatively, a substitute medication may be available.

In the case of a prolactinoma,

• radiation therapy,
• medications, or
• surgery

be considered.

All of these methods have advantages and disadvantages, and the approach depends on the individual case. Larger tumors that are already pressing on the optic nerve are usually removed surgically. Smaller prolactinomas, on the other hand, can be treated with medication or radiation therapy.