Clinical presentation is variable. Female patients most commonly present with oligomenorrhea, amenorrhea, reduced libido, or infertility (resulting from prolactin suppression of gonadotropin-releasing hormone [GnRH]). Galactorrhea in females may occur as a result of the physiologic effect of prolactin on breast epithelial cells. Male patients most commonly present with loss of libido, visual impairments, or headache. Decreased serum testosterone levels and hypogonadism in males may occur due to a decrease in luteinizing hormone (LH) and follicle-stimulating hormone (FSH) resulting from prolactin suppression of GnRH. In both male and female patients, a pituitary tumor may cause visual-field defects and headache.
Complications include osteoporosis, which may result from decreased gonadal steroid secretion.
E22.1 – Hyperprolactinemia
237662005 – Hyperprolactinemia
Differential Diagnosis & Pitfalls
- Pregnancy or breastfeeding can result in physiologically normal elevated prolactin levels.
- Macroprolactin can result in elevated prolactin levels without any clinical abnormality. The laboratory can precipitate macroprolactin prior to analysis for prolactin to avoid misdiagnosis.
- Chronic renal failure can result in decreased clearance of prolactin and increased secretion of prolactin.
- Chest wall injuries or nipple stimulation can transiently increase prolactin levels.
- Prolactinoma (prolactin-secreting pituitary tumor)
- Medication side effect (eg, dopamine antagonists such as some antipsychotics)
- Pituitary metastases (eg, pituitary tumor)
- Primary hypothyroidism can present with mild hyperprolactinemia.
- Increased pituitary size can be a normal variant in young women.
Drug Reaction Data