From the Guidelines
Persistently elevated prolactin is most commonly caused by prolactin-secreting pituitary tumors, medications, hypothyroidism, chronic kidney disease, and liver disease, and a thorough diagnostic workup is essential to determine the underlying cause. The diagnostic approach should include a thorough medication review, thyroid function tests, and kidney/liver function assessment, as recommended by the consensus guideline for the diagnosis and management of pituitary adenomas in childhood and adolescence 1. If these tests are normal, pituitary imaging, preferably MRI, should be performed to look for tumors.
Common Causes of Hyperprolactinemia
- Prolactin-secreting pituitary tumors (prolactinomas)
- Medications, such as antipsychotics, certain antidepressants, metoclopramide, and verapamil
- Hypothyroidism, which can cause hyperprolactinemia due to compensatory thyrotropin-releasing hormone hypersecretion and pituitary hyperplasia 1
- Chronic kidney disease, which can lead to increased prolactin secretion and reduced renal clearance 1
- Liver disease, which is associated with hyperprolactinemia in adults 1
Diagnostic Approach
- A single prolactin measurement taken at any time of the day is sufficient to assess hyperprolactinemia, as recommended by the consensus guideline 2
- Serial measurements over time may be considered to exclude the effect of stress and prolactin pulsatility 2
- Age-specific and sex-specific prolactin reference ranges should be used, and confounding conditions such as hypothyroidism, renal and/or hepatic impairment, and use of medications that cause hyperprolactinemia should be excluded 2
Treatment
- Discontinuing causative medications
- Treating hypothyroidism
- Using dopamine agonists like cabergoline (0.25-1mg twice weekly) or bromocriptine (2.5-15mg daily) for prolactinomas
- It is essential to note that prolactin elevation can cause hypogonadism, infertility, galactorrhea, and bone density loss if left untreated for extended periods, emphasizing the importance of prompt diagnosis and treatment.
From the Research
Causes of Persistently Elevated Prolactin
- Prolactin-secreting pituitary adenoma (prolactinoma) is a common cause of hyperprolactinemia, especially if serum prolactin levels are above 200 microg/L 3
- Other causes of hyperprolactinemia include: + Intake of various drugs 3, 4 + Compression of the pituitary stalk by other pathology 3 + Hypothyroidism 3 + Renal failure 3 + Cirrhosis 3 + Chest wall lesions 3 + Idiopathic hyperprolactinemia 3, 4
- Physiologic, pharmacologic, and pathologic causes can also contribute to hyperprolactinemia 4
Diagnosis and Treatment
- Dopamine agonists, such as bromocriptine and cabergoline, are commonly used to treat hyperprolactinemia 5, 3, 6, 4, 7
- Cabergoline has been shown to be more effective than bromocriptine in reducing prolactin levels and improving symptoms 6, 4, 7
- Surgery and radiotherapy may be considered for patients who are resistant to or intolerant of dopamine agonists 3, 7
- Regular monitoring of prolactin levels and pituitary imaging is recommended for patients with hyperprolactinemia, especially those with macroprolactinoma 5, 3