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Deena Adimoolam, MD
The Pituitary Society
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What is hyperprolactinemia?
Hyperprolactinemia is a condition in which a person has higher-than-normal levels of the hormone prolactin in the blood. The main function of prolactin is to stimulate breast milk production after childbirth, so high prolactin levels are normal in pregnancy. Prolactin also affects the levels of sex hormones (estrogen and testosterone) in both women and men. Prolactin is made by the pituitary gland, a pea-sized organ found at the base of the brain.
What causes hyperprolactinemia?
One common cause of hyperprolactinemia is a growth or tumor on the pituitary gland called a prolactinoma. The tumor produces high levels of prolactin. These tumors can be large or small and are usually benign, meaning they are not cancerous. Large tumors can also cause headaches, vision problems, or both. Prolactinomas are more common in women than in men and rarely occur in children.
Certain prescription medicines can also increase prolactin levels. These include medicines for:
- High blood pressure (such as calcium-channel blockers and methyldopa)
- Depression (tricyclic and SSRI antidepressants)
- Heartburn and gastroesphageal reflux disease
- Nausea and vomiting
- Pain (opiates—drugs derived from opium)
- Serious mental health disorders (antipsychotics such as risperdal and haloperidol)
- Menopausal symptoms (estrogen)
Other causes include:
- Hypothyroidism or underactive thyroid—meaning the thyroid gland does not produce enough thyroid hormone
- Chest-wall injuries or other conditions that affect the chest wall, such as shingles
- Other tumors and diseases affecting the pituitary gland, or radiation treatment for tumors on or near the pituitary
- Chronic liver and kidney diseases
Sometimes, no cause for hyperprolactinemia can be found.
What are the signs and symptoms of hyperprolactinemia?
Both men and women may have infertility, decreased sex drive, and bone loss. In addition, women may have:
- Vaginal dryness, leading to pain during intercourse
- Problems with menstruation—having no periods or irregular periods
- Production of breast milk when not pregnant or nursing
Men may also have:
- Erectile dysfunction—trouble getting or keeping an erection
- Breast enlargement, called gynecomastia
- Decreased muscle mass and body hair
How is hyperprolactinemia diagnosed?
A blood test is used to detect excess prolactin. If prolactin levels are high, more tests are usually done to check blood levels of thyroid hormone. Normal thyroid hormone levels rule out hypothyroidism as a cause of hyperprolactinemia. Doctors will also ask about other conditions and medication use, and rule out pregnancy.
If a prolactinoma is suspected, an MRI (magnetic resonance imaging) of the brain and pituitary is often the next step. Using a special machine that creates images of body tissues, an MRI can reveal a pituitary tumor and show its size.
What is the treatment for hyperprolactinemia?
Treatment is based on the cause. Some people with high prolactin levels, but few or no signs and symptoms, do not need any treatment. Options for treating tumors include:
- Prescription medicines. Bromocriptine and cabergoline decrease prolactin production. Medicines work well for most people with prolactinomas.
- Surgery to remove a tumor. Surgery may be used if medicines have not been effective. Surgery is sometimes needed if the tumor is affecting vision.
- Radiation. Rarely, if medicines and surgery have not been effective, radiation is used to shrink the tumor.
Bromocriptine and cabergoline are also used to treat hyperprolactinemia with no known cause. Hypothyroidism is treated with synthetic thyroid hormone, which should bring prolactin levels back to normal. If high prolactin levels are caused by prescription medications, other types of medications can be explored.
Questions to ask your doctor
- What caused my hyperprolactinemia?
- What tests do I need?
- What are my options for treatment?
- What are the advantages and disadvantages of each treatment option?
- Will I have long-term side effects from my condition?
Edited: November 2017
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Why is a prolactin level test done?
Last reviewed Wed 27 Jun 2018
- When to measure
- Prolactin and fertility
- Insurance and cost
Prolactin is the hormone that tells the body to make breast milk when a person is pregnant or breast-feeding. Production of prolactin takes place in the pituitary gland.
For most men and women who are not pregnant or breast-feeding, there are only low levels of prolactin in the body. Doctors measure the hormone levels in nanograms per milliliter (ng/mL).
Normal levels are:
- females: less than 25 ng/mL
- males: less than 17 ng/mL
A prolactin level test is simple and measures the amount of the hormone in the blood. It can check to see if levels are too low or too high.
When should prolactin levels be measured?
A blood test can measure prolactin levels.
Doctors will measure prolactin levels to obtain more information about someone’s health.
They may check levels of other hormones at the same time. This information can help explain the cause of specific medical concerns.
A doctor may recommend a prolactin level test if someone:
- produces breast milk when not pregnant or breast-feeding
- has symptoms of a growth on the pituitary gland called a prolactinoma
- has another pituitary disorder
- experiences infertility or irregular periods
- has a medical condition that affects how much dopamine they make
What is the procedure?
A technician will take a small blood sample from a vein in a person’s arm. They will then send the sample for testing.
The natural levels of prolactin in the body change throughout the day. Levels gradually rise overnight and are at their highest in the morning.
Doctors usually ask to take a blood sample 3 to 4 hours after a person has woken up.
What do the results mean?
A disorder of the pituitary gland may cause high prolactin levels.
Usually, it is not necessary to treat low levels of prolactin.
A common cause of low levels is medication. Some examples include dopamine and levodopa. In some cases, low levels of prolactin may be a sign of a pituitary disorder, for example, hypopituitarism.
This is a rare condition that can delay growth and puberty in children, and cause premature aging in adults.
Prolactin levels of between 30 ng/mL and 200 ng/mL are considered moderately high. This level of prolactin in the blood can have many causes.
Conditions related to raised levels of prolactin include:
- pituitary disorders
- polycystic ovary syndrome (PCOS)
- kidney disease
- liver disease
- anorexia nervosa
If test results show high levels of prolactin, further tests may be needed.
If a doctor suspects that a prolactinoma is causing high levels, they may recommend a CT or MRI scan .
The scan can look at the pituitary gland and show if there is a growth and how large it has become. Doctors can then decide what action and treatment to recommend.
A prolactinoma will usually remain small in females. It often does not cause other health problems, although it will affect hormone levels.
A prolactinoma can be large in men. The growth may put pressure on the nerves between the brain and the eye. This can cause problems with vision and headaches .
How do prolactin levels affect fertility?
For women, high levels of prolactin in the blood can stop the ovaries from making the hormone estrogen .
Low levels of estrogen can cause irregular periods or stop periods completely, reduce sex drive, and cause vaginal dryness. A person may also find it more challenging to get pregnant.
For men, high levels of prolactin can cause erectile dysfunction and low sex drive.
This effect in men is because prolactin can stop the testes from producing the hormone testosterone . In some cases, it may cause infertility, but this is rare.
Treatment for high prolactin levels
Medication is the standard treatment for high prolactin.
High prolactin levels are normal during pregnancy and while someone is breast-feeding. Some medical conditions may raise levels including:
- lung cancer
- stress caused by illness
- trauma to the chest wall
Some medications can cause high prolactin levels, including:
- some antidepressants
- drugs containing estrogen, such as birth control pills
- medication used to treat hypertension
- some medications used to treat acid reflux
Marijuana use can also cause prolactin levels to rise.
A doctor will usually ask about medical history and any drugs a person is taking before they do a prolactin level test.
Treatment for high levels is usually with medication, normally Parlodel or Dostinex.
If someone has a prolactinoma, medication can usually reduce the size of the tumor .
The medication used to treat high levels can cause side effects, such as nausea and stomach issues. Doctors will only gradually increase the amount of medication they prescribe to a person for this reason.
Surgery may be used to treat small tumors. Tumors are usually smaller in females than in males and are often easier to remove.
Surgery may also sometimes be recommended if medication has not been successful.
Insurance and cost
Hormone testing is not classed as an essential health benefit, so there is no legal requirement for an insurance plan to cover it. But every insurance plan is different, and many will cover a prolactin level test.
The cost of the test varies widely, depending on the test provider. The price can range from $20 to $32 with health insurance , to $140 or more without.
Raised levels of prolactin may indicate an underlying health condition. Higher levels are normal in pregnant women and those who are breast-feeding.
The test to measure prolactin levels is simple and can help doctors to prescribe the correct medication to reduce levels or provide treatment for an underlying condition that may be causing the raised levels.
Progesterone and progestin: How do they work?
Find out a out the role of the hormone progesterone in the human body, how an imbalance can affect both women and men, and how it can be treated.
What is hypothyroidism?
Hypothyroidism is when the thyroid gland is not making enough hormones for good health. Symptoms can progress slowly and be vague and hard to identify. Hypothyroidism is complicated as many factors affect the thyroid, including certain foods and supplements. Find out about hypothyroidism here and who may be at risk.
Bioidentical hormones: How are they used?
Bioidentical hormones can be used in hormone therapy to relieve the symptoms of menopause, such as hot flashes. They are a synthetic form of hormone that mimic the action of naturally produced hormones. They can be used as creams, injections, and so on. Not all of these products have been proven safe and effective.
Infertility in men and women
Infertility or a couple being unable to conceive a child can cause significant stress and unhappiness. There are numerous reasons for both male and female infertility but many ways in which medical assistance can overcome problems that people may face. Everything concerning infertility is discussed and explained here.
Hypophysectomy: What does it involve?
A hypophysectomy is a procedure to remove the pituitary gland because there is a benign or malignant tumor present. This is a difficult procedure that can take up to 2 hours to perform. After, the person may need hormone replacement therapy. Alternative solutions should be considered before deciding to go ahead.
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Article last reviewed by Wed 27 June 2018.
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All references are available in the References tab.
Costs of hormone testing. (n.d.). Retrieved from https://www.maleinfertilityguide.com/hormone-testing-cost-maleinfertilty-slowspermmotility/#
Hyperprolactinemia. (2017, November). Retrieved from https://www.hormone.org/diseases-and-conditions/pituitary/hyperprolactinemia
Hypopituitarism. (2017, November). Retrieved from https://www.hormone.org/diseases-and-conditions/pituitary/hypopituitarism
Hypothyroidism (underactive). (n.d.). Retrieved from: https://www.thyroid.org/hypothyroidism/
Prolactin. (2018, June 27). Retrieved from https://labtestsonline.org/tests/prolactin
Prolactinoma – what are the symptoms of a prolactinoma? (n.d.). Retrieved from https://www.pituitarysociety.org/patient-education/pituitary-disorders/prolactinoma/symptoms
Prolactinoma – what is a prolactinoma? (n.d.). Retrieved from https://www.pituitarysociety.org/patient-education/pituitary-disorders/prolactinoma/what-is-prolactinoma
Prolactinomas. (n.d.). Retrieved from https://pituitary.org/knowledge-base/disorders/prolactinomas
What marketplace health insurance plans cover. (n.d.). Retrieved from https://www.healthcare.gov/coverage/what-marketplace-plans-cover/
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