At a Glance
Hyperprolactinemia is the most common endocrine disorder of the hypothalamic-pituitary unit. In premenopausal women, hyperprolactinemia causes hypogonadism, leading to symptoms of infertility, oligomenorrhea or amenorrhea, and galactorrhea. Hyperprolactinemia is often clinically silent in postmenopausal women who, by definition, are already hypogonadal. In men, hyperprolactinemia causes hypogonadism manifested by decreased libido, impotence, infertility, and, rarely, galactorrhea.
Several drugs are known to cause minimal to moderate hyperprolactinemia:
Anticonvulsants
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Phenytoin
Antidepressants
Tricyclic antidepressants
Selective serotonin reuptake inhibitors
Antihypertensives
Labetolol
Verapamil
Catecholamine-depleting agents
Reserpine
Dopaminergic-blocking agents
Pheothiazines
Butyrophenones
Benzamides
Dopamine-depleting agents
α-methyldopa
Estrogens
H2-receptor blocking agents
Cimetidine
Ranitidine
Neuroleptics
Chlorpromazine
Promazine
Trifluoperazine
Fluphenazine
Butaperazine
Perphenazine
Thiethylperazine
Thioridazine
Haloperidol
Pimozide
Thiothixene
Molindone
Neuropeptides
Thyroid-releasing hormone
Opiates and Opiate Antagonists
Heroin
Methadone
Apomorphine
Morphine
Oral contraceptives
These should be ruled-out as potential causes of hyperprolactinemia prior to investigating organic causes.
What Tests Should I Request to Confirm My Clinical Dx? In addition, what follow-up tests might be useful?
Measurement of serum prolactin is necessary to identify hyperprolactinemia. Testing can be performed without regard to time of day, because routine daily activities have little influence on prolactin concentration.
Are There Any Factors That Might Affect the Lab Results? In particular, does your patient take any medications – OTC drugs or Herbals – that might affect the lab results?
Prolactin concentrations slightly greater than the reference interval should be confirmed by repeat testing on a new blood sample, because prolactin may be influenced by strenuous exercise, emotional or physical stress, or rigorous stimulation of breast tissue.
Macroprolactin is a complex of prolactin and IgG and is a source of hyperprolactinemia in some individuals. Because of its high molecular mass, macroprolactin has prolonged clearance that can cause an apparent hyperprolactinemia. In the absence of clinical symptoms, hyperprolactinemia due to macroprolactin can cause clinical confusion. It is important to be aware that macroprolactinemia can coexist with true hyperprolactinemia.
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