Endocrinology & Metabolic

Hyperprolactinaemia

Hyperprolactinaemia is a raised prolactin concentration caused by physiology, medicines, systemic disease, stalk interruption or a prolactinoma; confirm the result and find the cause before treating the number.

Definition

Hyperprolactinaemia is a persistent serum prolactin concentration above the laboratory reference range. Causes include pregnancy, lactation, stress, medicines, hypothyroidism, renal or systemic disease, macroprolactin, stalk interruption and a prolactin-secreting pituitary adenoma.

First principles

Dopamine normally restrains prolactin

Hypothalamic dopamine reaches lactotrophs through the pituitary stalk and tonically inhibits prolactin release. Dopamine-blocking medicines, stalk compression and loss of dopaminergic delivery therefore raise prolactin; a prolactinoma produces autonomous secretion and may enlarge the gland.

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