Clinical manifestations and evaluation of hyperprolactinemia
- Peter J Snyder, MD
Peter J Snyder, MD
- Editor-in-Chief — Endocrinology
- Section Editor — Pituitary Disease; Male Reproductive Endocrinology
- Professor of Medicine
- University of Pennsylvania School of Medicine
The clinical manifestations of hyperprolactinemia are relatively few and usually easy to recognize. Once the presence of prolactin excess is identified, further evaluation to establish the underlying cause is usually straightforward. The clinical manifestations and evaluation of hyperprolactinemia are reviewed here. The causes and treatment of hyperprolactinemia are discussed elsewhere. (See "Causes of hyperprolactinemia" and "Management of hyperprolactinemia".)
Hyperprolactinemia causes typical symptoms in premenopausal women and in men but not in postmenopausal women.
Premenopausal women — Hyperprolactinemia in premenopausal women causes hypogonadism, with symptoms that include infertility, oligomenorrhea, or amenorrhea [1,2] and less often galactorrhea. In a retrospective study of 104 patients with hyperprolactinemia ages 30 to 44 years, the most commonly reported symptoms were infertility, headache, and oligomenorrhea in 48, 39, and 29 percent, respectively . Galactorrhea was slightly less common (24 percent).
Menstrual cycle dysfunction — Excluding pregnancy, hyperprolactinemia accounts for approximately 10 to 20 percent of cases of amenorrhea. The mechanism appears to involve inhibition of luteinizing hormone (LH), and perhaps follicle-stimulating hormone (FSH) secretion, via inhibition of the release of gonadotropin-releasing hormone (GnRH). As a result, serum gonadotropin concentrations are normal or low, as in other causes of secondary hypogonadism.
The symptoms of hypogonadism due to hyperprolactinemia in premenopausal women correlate with the magnitude of the hyperprolactinemia. In most laboratories, a serum prolactin concentration above 15 to 20 ng/mL (15 to 20 mcg/L SI units) is considered abnormally high in women of reproductive age.
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- CLINICAL PRESENTATION
- Premenopausal women
- - Menstrual cycle dysfunction
- - Bone density
- - Galactorrhea
- Postmenopausal women
- Serum prolactin concentrations
- Pitfalls in diagnosis
- - Hook effect
- - Macroprolactin
- EVALUATION OF HYPERPROLACTINEMIA
- Physical examination
- Laboratory/imaging tests
- - MRI in drug-induced hyperprolactinemia
- GALACTORRHEA WITHOUT HYPERPROLACTINEMIA
- INFORMATION FOR PATIENTS