Which specialist treats hypoprolactinemia (low prolactin levels)?

Which Specialist Treats Hypoprolactinemia

Endocrinologists are the primary specialists who evaluate and manage hypoprolactinemia, often working in collaboration with neurosurgeons when structural pituitary pathology is present. 1

Primary Specialist: Endocrinology

• Endocrinologists have primary responsibility for the evaluation and management of reproductive endocrine disorders, including hypoprolactinemia. 1
• The Journal of Neurology, Neurosurgery and Psychiatry explicitly states that "the evaluation of reproductive endocrine disorders typically falls into the domain of the endocrinologist and gynaecologist." 1
• Patients with persistently abnormal prolactin levels of unknown etiology should undergo evaluation for endocrine disorders by an endocrinologist. 1

When Multidisciplinary Collaboration is Required

Hypoprolactinemia rarely occurs in isolation and typically indicates severe pituitary damage requiring coordinated specialist care. 2, 3

Neurosurgery Involvement

• Neurosurgeons become involved when structural pituitary lesions (adenomas, mass effects) are identified that may require surgical intervention. 1
• The Congress of Neurological Surgeons guidelines emphasize that routine endocrine analysis of all anterior pituitary axes should be performed in patients with pituitary adenomas, with endocrinologists managing the hormonal aspects. 1
• Close cooperation between neurologists/neurosurgeons and endocrinologists is essential, as these specialists may not have detailed understanding of each other's domains. 1

Gynecology/Reproductive Endocrinology

• Gynecologists or reproductive endocrinologists should be consulted for women with hypoprolactinemia presenting with reproductive dysfunction, menstrual disorders, or fertility concerns. 1
• Women with testosterone deficiency who are interested in fertility should have reproductive health evaluation performed. 1

Pediatric Endocrinology

• Pediatric endocrinologists manage hypoprolactinemia in children and young people, particularly when associated with pituitary adenomas or genetic syndromes. 1
• The Nature Reviews Endocrinology consensus guideline emphasizes that pituitary disorders in children require collaboration between pediatric and adult pituitary specialists as part of multidisciplinary teams. 1

Clinical Context: Why Hypoprolactinemia Matters

Hypoprolactinemia is a marker of severe pituitary dysfunction and is universally associated with other hormone deficiencies, particularly growth hormone deficiency. 2, 3

• Prolactin deficiency generally occurs when large pituitary tumors, pituitary apoplexy, or other conditions with sellar mass effect lead to global hypopituitarism. 2
• Prolactin is commonly the last anterior pituitary hormone affected, after growth hormone and gonadotropins are lost. 2
• All patients with acquired prolactin deficiency have evidence of severe growth hormone deficiency and typically have multiple other pituitary hormone deficiencies. 3
• The prevalence of acquired prolactin deficiency in treated Cushing's disease is 20.97%, but only 2.93% in other pituitary disorders. 3

Critical Pitfall to Avoid

Do not focus exclusively on the low prolactin level while missing the underlying cause—hypoprolactinemia indicates severe hypopituitarism requiring comprehensive pituitary axis evaluation. 4, 3

• No patient with isolated prolactin deficiency has been identified in clinical studies; it always occurs with other hormone deficiencies. 3
• Hypoprolactinemia has been associated with metabolic dysfunction, sexual dysfunction, and neuropsychologic alterations. 5
• Currently, no specific replacement therapy for prolactin is commercially available, though recombinant human prolactin has been used experimentally for lactation support. 2