Understanding and treating hyperprolactinemia

Commentary

Newsday

11 Minutes Ago

Dr Maxwell Adeyemi –

Dr Maxwell Adeyemi

Prolactin is a hormone produced from the pituitary gland. It is mainly responsible for the development of mammary glands within breast tissue, milk production and lactation. It also contributes to several bodily processes and functions. The pituitary gland is responsible for producing and secreting prolactin, but other body systems and parts are also capable of producing prolactin such as the central nervous system, immune system, uterus and mammary glands.

Prolactin levels are normally low in males at birth and non-lactating and non-pregnant people. High prolactin levels is normal during pregnancy or breast feeding.

Hyperprolactinemia is a condition in which there is a higher-than-normal level of prolactin in the blood. While it may not be life-threatening, it can cause infertility and other issues. It most commonly affects people under the age of 40 and is more common in women. It is rare in children.

Causes

路 Prolactinoma, a benign tumour of the pituitary gland (most common cause)

路 Other pituitary gland tumours

路 Certain medications

路 Certain medical conditions

Medical conditions other than a prolactinoma that may increase prolactin levels in the blood include:

路 Hypothyroidism (underactive thyroid)

路 Kidney disease

路 Shingles, especially if the rash or blisters are on the chest

路 Chest wall injuries such as fractured ribs, fractured breastbone and bruising on the lungs.

路 Polycystic ovary syndrome

路 Cushing鈥檚 syndrome

路 Nelson syndrome

路 Liver disease

路 Infection, tumours or trauma of the hypothalamus.

路 Radiation treatment for tumours on or near the pituitary gland

The brain chemical, dopamine, helps suppress the production of prolactin in your body. Any medication that affects the production or use of dopamine can make your prolactin levels rise. Medications that can increase prolactin levels in your blood include:

路 High blood pressure medications such as calcium, channel blockers and methyldopa.

路 Certain anti-psychotic medications such as risperidone and haloperidol.

路 Medications that treat nausea and vomiting.

路 Medications that treat heartburn and gastroesophageal reflux disease.

路 Birth control pills.

路 Pain relievers that contain opioids.

路 Medications that treat menopause symptoms such as oestrogen therapy.

Signs and symptoms

Some people who have hyperprolactinemia have very mild or no symptoms at all. But generally, it can cause:

路 Infertility

路 Loss of interest in sex

路 Low bone mass

路 Milky discharge from the nipples when not pregnant or breast feeding

路 Changes in menstruation not related to menopause, such as irregular or no periods

路 Pain or discomfort during penetrative sex due to vaginal dryness.

Painful breasts

路 Erectile dysfunction

路 Low levels of testosterone

路 Enlarged breast tissue

路 Headaches

路 Visual changes

Diagnosis

If you experience signs and symptoms of hyperprolactinemia, your healthcare provider will likely order a prolactin level blood test for you. If the results show that you have hyperprolactinemia the next step will be to determine the cause. Your health care provider may have you undergo additional testing, such as other blood tests and imaging tests and may eventually refer you to an endocrinologist.

Treatment

The treatment for hyperprolactinemia depends on its cause. Some people who have high prolactin levels but have few or no symptoms don鈥檛 need treatment.

Treatment options for prolactinomas include:

路 Medication called dopamine agonists control prolactin levels and are very effective in shrinking prolactinoma tumours.

路 If medication is not working to shrink the prolactinoma, surgery may be needed to remove it.

路 Radiation therapy is a rare third option if medication and/or surgery do not work.

If prescription medication is the cause of hyperprolactinemia, your healthcare provider may prescribe other similar types of medications that do not increase prolactin levels. Generally, hyperprolactinemia is treatable once diagnosed early and appropriate intervention is made.

Contact Dr Maxwell on 363-1807 and 757-5411.