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Dx High Prolactin Treatments:


"Hyperprolactinemia is a condition of elevated serum prolactin; its primary function is to enhance breast development during pregnancy and to induce lactation. Secretion is pulsatile; it increases with sleep, stress, pregnancy, and chest wall stimulation or trauma, and therefore must be drawn after fasting. Normal fasting values are generally less than 25-30 ng/mL; normal levels are also generally higher in women.

Nonpuerperal hyperprolactinemia is a state in which pituitary lactotroph adenomas produce prolactin. These lactotroph adenomas are called prolactinomas and account for approximately 40% of all pituitary tumors. However, hyperprolactinemia can also be from a pharmacologic cause or some other pathologic problem. Idiopathic hyperprolactinemia is possible though a diagnosis of exclusion.

The primary action of prolactin is to maintaining milk production. However, lactation is inhibited by the high levels of estrogen and progesterone during pregnancy. The rapid decline of estrogen and progesterone in the postpartum period allows lactation to commence. During lactation and breastfeeding, ovulation may be suppressed, but may return before menstruation resumes. Therefore, this [lactation] cannot be considered a reliable form of birth control.

This condition occurs in less than 1% of the general population and in 5-14% of patients presenting with secondary amenorrhea.[2] Approximately 75% of patients presenting with galactorrhea and amenorrhea have hyperprolactinemia. Of these patients, approximately 30% have prolactin-secreting tumors.

Mortality is unlikely; however, in cases where the condition is due to a large prolactin-secreting tumor local mass effect can lead to significant morbidity.

The condition causes systemic complaints that often resolve when the prolactin level returns to normal or once the tumor shrinks.

Rare cases of metastatic malignant prolactinoma have been described in the literature, but they number less than 50. Bone resorption can be seen due to sex steroid attenuation mediated by the hyperprolactinemic state. A 25% decrease in spinal bone density can be seen in women with hyperprolactinemia and may be irreversible, even with normalization of prolactin levels.

Clinical presentation in women is more obvious and occurs earlier than in men. They typically present with oligomenorrhea, amenorrhea, galactorrhea, or infertility. Galactorrhea is less common in postmenopausal women due to lack of estrogen. If a pituitary tumor is present, it is a microadenoma (< 10 mm) approximately 90% of the time.

Prolactinoma is less common in men than in women, typically presenting as an incidental finding on a brain CT scan or MRI, or with symptoms of tumor mass effect. This is most evident as a complaint of visual disturbances or headache. By the time of diagnosis in men, approximately 60% have macroprolactinomas." <>td>

Medications Used in Treatment:
1. Ergot Derivatives: cabergoline, ParlodelĀ®/bromocriptine

*[Editor]The Effects of Anti-psychotics on Prolactin Levels is that high prolactin interferes with male sexual performance, may increase milk discharge from breasts (both sexes) and interferes with normal ovulation and fertility.

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