From the Research
Anorexia nervosa (AN) typically does not cause hyperprolactinemia, as patients with AN often have normal or low prolactin levels due to chronic malnutrition and low body weight. The severe caloric restriction and resulting hormonal dysregulation in anorexia nervosa primarily affects the hypothalamic-pituitary-gonadal axis, leading to low levels of sex hormones (estrogen in females, testosterone in males) and amenorrhea in females, but not elevated prolactin 1.
Key Points
- The hormonal changes in anorexia are characterized by adaptations to conserve energy, including suppression of reproductive function, thyroid hormone alterations, and elevated cortisol levels.
- If hyperprolactinemia is found in a patient with apparent anorexia nervosa, clinicians should investigate other potential causes such as medications (particularly antipsychotics, some antidepressants, and antiemetics), pituitary adenomas, hypothyroidism, or other conditions that might be coincidental or contributing to the clinical picture rather than attributing it to the eating disorder itself 2.
- Studies have shown that basal prolactin levels are well within the normal range in patients with anorexia nervosa, and there is no significant change in basal levels during weight gain 3.
- The use of antipsychotics with high D2 receptor affinity for the augmented treatment of AN increases the potential risk of PRL-mediated adverse effects, but this is not a direct result of the anorexia nervosa itself 1.
Considerations
- Clinicians should be aware of the potential for hyperprolactinemia in patients with anorexia nervosa who are taking certain medications, and monitor prolactin levels accordingly.
- The diagnosis of hyperprolactinemia in a patient with anorexia nervosa should prompt a thorough investigation into potential underlying causes, rather than attributing it to the eating disorder itself.