hyperprolactinemia
HYPERPROLACTINEMIA
Hyperprolactinemia is the presence of elevated prolactin levels that occurs in about one-thirds of patients w/ chronic kidney disease & resolves after successful transplantation.
It may cause visual field defects or headache in both men and women.
In women, signs and symptoms include menstrual irregularity, galactorrhea, infertility, vaginal dryness, dyspareunia, loss of libido and reduction in vertebral bone density (in sustained, pronounced hyperprolactinemia).
While in men, signs and symptoms include diminished libido, hypogonadism, gonadotrophin suppression, osteopenia, decreased muscle mass, and decreased facial hair that may occur in prolonged hyperprolactinemia.

Definition

  • Hyperprolactinemia is the presence of elevated prolactin levels

Etiology

Physiologic

  • Pregnancy
  • Lactation
  • Chest wall stimulation
  • Stress
  • Sleep
  • Coitus
  • Exercise

Drug-Induced

  • Dopamine receptor blockers
    • Thioxanthines
    • Phenothiazines eg Chlorpromazine, Perphenazine
    • Butyrophenones eg Haloperidol
    • Metoclopramide
  • Dopamine synthesis inhibitors
    • Methyldopa
  • Opiates and opiate antagonists
  • H2-receptor antagonists (H2RA) eg Cimetidine, Ranitidine
  • Catecholamine depletors
    • Reserpine
  • Imipramines eg Amitriptyline, Amoxapine
  • Hormones eg Estrogens
  • Calcium antagonists
    • Verapamil
  • Selective serotonin reuptake inhibitor (SSRI)
    • Fluoxetine
  • Anesthetics
  • Anticonvulsants eg Phenytoin

Neurogenic Disorders

  • Lesions on the chest wall
  • Spinal cord injury
  • Stimulation of breast

Systemic Disorders

  • Hypothyroidism
  • Chronic renal failure (CRF)
  • Cirrhosis
  • Epileptic seizures
  • Polycystic ovarian disease
  • Pseudocyesis

Pituitary Hypersecretion

  • Acromegaly
  • Prolactinoma (most common cause of prolactin levels >100 mcg/L)
  • Macroprolactinemia
  • Plurihormonal adenoma
  • Macroadenoma (compressive)

Hypothalamic-Pituitary Stalk Damage

  • Tumors (eg craniopharyngoma, germinoma, hypothalamic metastases, meningioma)
  • Empty sella
  • Adenoma with stalk compression
  • Lymphocytic hypophysitis
  • Rathke’s cyst
  • Irradiation
  • Trauma (eg pituitary stalk section, suprasellar surgery)
  • Granulomas
  • Infiltrations

Production of Ectopic Prolactin

  • Non-Hodgkin lymphoma
  • Colorectal adenocarcinoma
  • Renal cell carcinoma
  • Ovarian teratomas
  • Gonadoblastoma
  • Uterine cervical carcinoma

Signs and Symptoms

  • For both sexes, a pituitary tumor may cause visual field defects or headache

Women

  • Menstrual irregularity
  • Galactorrhea
  • Infertility
  • Vaginal dryness
  • Dyspareunia
  • Loss of libido
  • Reduction in vertebral bone mineral density in sustained, pronounced hyperprolactinemia

Men

  • Diminished libido
  • Visual loss caused by optic nerve compression
    • Extraocular muscle weakness
  • Hypogonadism
  • True galactorrhea is uncommon
  • Gonadotropin suppression
    • Reduced testosterone
    • Impotence
    • Oligospermia
  • Osteopenia, decreased muscle mass and decreased facial hair may occur in prolonged hyperprolactinemia
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