From the Guidelines
Hyperprolactinemia is linked to obesity through several mechanisms, including increased food intake, reduced fat breakdown, and promoted fat storage, particularly in women, as evidenced by a study published in 2024 1. The relationship between hyperprolactinemia and obesity is complex and bidirectional. On one hand, hyperprolactinemia can lead to obesity by disrupting normal metabolism and sex hormone balance. Prolactin can interfere with dopamine signaling in the brain's reward centers, potentially increasing appetite and cravings. Additionally, hyperprolactinemia can suppress estrogen and testosterone, leading to increased abdominal fat deposition and insulin resistance.
- Key factors contributing to this relationship include:
- Increased food intake and reduced fat breakdown
- Disrupted sex hormone balance
- Suppressed estrogen and testosterone
- Increased abdominal fat deposition and insulin resistance On the other hand, obesity itself can increase prolactin production, creating a cycle where excess weight leads to higher prolactin, which then promotes further weight gain.
- A study published in 2024 found that 46% of children and adolescents with macroprolactinomas had overweight or obesity at diagnosis, and 23% cited weight gain as one of the reasons for seeking medical advice 1. Treatment of hyperprolactinemia-related obesity typically involves addressing the underlying cause of elevated prolactin with dopamine agonists like cabergoline or bromocriptine, as well as weight management strategies including diet modification and increased physical activity.
- Dopamine agonists can help reduce prolactin levels and alleviate symptoms associated with hyperprolactinemia.
- Weight management strategies can help reduce excess weight and improve insulin sensitivity, thereby breaking the cycle of hyperprolactinemia and obesity. It is essential to consider the potential relationship between hyperprolactinemia and obesity in clinical practice, particularly in patients with pituitary adenomas or other conditions that may contribute to elevated prolactin levels 1.
From the Research
Relationship Between Hyperprolactinemia and Obesity
- Hyperprolactinemia may be associated with a high prevalence of obesity, but the nature of this link is poorly defined 2.
- Studies have shown that weight gain and elevated body weight are frequently associated with prolactinomas, regardless of a mass effect on the hypothalamus or pituitary function 2, 3.
- Normalization of prolactin levels can result in weight loss, as seen in patients with prolactinomas who underwent dopamine agonist therapy 2, 3, 4.
Clinical Presentations and Treatment Outcomes
- Weight gain can be a presenting symptom for patients with newly diagnosed prolactinomas, and those with prolactinomas have a higher body mass index (BMI) and an increased prevalence of class II obesity 5.
- Treatment with dopamine agonists, such as cabergoline and bromocriptine, can normalize plasma prolactin levels and improve metabolic and cardiovascular risk factors in patients with elevated prolactin levels 6.
- Cabergoline has been shown to be superior to bromocriptine in affecting atherogenic dyslipidaemia, insulin sensitivity, and circulating levels of cardiovascular risk factors in hyperprolactinemic patients 6.
Correlation Between Prolactin Levels and BMI
- A correlation has been observed between BMI and log-transformed prolactin levels in patients with prolactinomas, suggesting a potential link between prolactin secretion and weight change 5.
- Further studies are needed to examine the relationship between prolactin secretion and weight change in larger populations 4, 5.