Hyperprolactinemia is a condition characterized by elevated levels of prolactin, a hormone primarily responsible for milk production in women. While prolactin plays an essential role during pregnancy and breastfeeding, its excessive production outside these contexts can lead to health concerns in both women and men.

This condition can stem from a variety of causes, including physiological processes (like pregnancy or stress), certain medications, and medical conditions such as prolactinomas—benign tumors of the pituitary gland that overproduce prolactin.

How Common Is It?

Hyperprolactinemia is more common than many realize, with its prevalence increasing over recent years due to better diagnostic tools and medication use. For example, a study in Scotland found that cases rose significantly over two decades, partly due to the widespread use of medications such as antipsychotics and antidepressants. Additionally, prolactinomas affect approximately 50 out of every 100,000 people, with ~ 5 new cases diagnosed annually per 100,000 individuals.

Symptoms of Hyperprolactinemia

The symptoms vary between women and men, reflecting prolactin’s distinct effects on reproductive and hormonal systems:

In Women:

• Irregular or absent menstrual periods (amenorrhea or oligomenorrhea)

• Unexpected breast milk production (galactorrhea)

• Reduced libido and infertility

In Men:

• Decreased libido and erectile dysfunction

• Breast tissue enlargement (gynecomastia)

• Low sperm count and infertility

If hyperprolactinemia is caused by a prolactinoma, both men and women may experience symptoms due to the tumor’s pressure on surrounding structures, including headaches or vision problems. But, this is only seen with larger prolactinomas.

Diagnosing Hyperprolactinemia

Diagnosing hyperprolactinemia starts with measuring prolactin levels in the blood. To identify the root cause, doctors may rule out secondary factors like pregnancy, thyroid dysfunction, or kidney problems. For those with significantly high prolactin levels, imaging studies such as MRI are often recommended to check for pituitary tumors.

Treating Hyperprolactinemia

The treatment depends on the underlying cause:

• Medications: Dopamine agonists like cabergoline are the first-line treatment. These medications effectively lower prolactin levels and often shrink prolactinomas. Bromocriptine is another option, particularly for women planning pregnancy due to its well-documented safety.

• Surgery: For individuals with prolactinomas who cannot tolerate medications or have large tumors causing significant symptoms, minimally invasive surgery may be needed.

• Radiotherapy: Rarely used, it’s reserved for aggressive or treatment-resistant pituitary tumors.

Why Early Diagnosis Matters

If left untreated, hyperprolactinemia can lead to long-term complications such as infertility, bone loss (osteopenia), and, in severe cases, significant tumor-related symptoms. Fortunately, with proper evaluation and treatment, most patients experience symptom relief and can manage the condition effectively.

How Dr. Hasan Can Help

At Chia Endocrinology & Wellness, Dr. Farhad Hasan has extensive experience in diagnosing and treating pituitary disorders, including hyperprolactinemia and prolactinomas. He previously served as the co-director of AHN Pituitary Center. Whether you’re dealing with symptoms or seeking a second opinion, Dr. Hasan’s practice is dedicated to providing personalized care tailored to your needs.

Useful Reference: Prolactinomas Booklet (Pituitary Society)