Pituitary gland is a small gland in the middle of the head just below the brain. The pituitary contains lactotroph cells that produce prolactin, the hormone that stimulates breast milk.
High prolactin can be due to multiple causes. Physiologically high prolactin occurs in pregnancy and lactation. Other common causes for high prolactin are drug induced, hypothyroidism, chronic renal failure, estrogen therapy, chest wall injury and stress. Prolactinoma, prolactin secreting pituitary adenoma, leads to very high levels of prolactin. Non functioning pituitary tumors can cause mild to moderate increase in high prolactin via compressing pituitary stalk.
High prolactin levels cause milk discharge from the breasts. In women, it can lead to irregular or absent menstrual periods, infertility, menopausal symptoms (hot flashes and vaginal dryness), and weakness of bones. In males, high prolactin can lead to low testosterone levels. Low testosterone levels can cause erectile dysfunction, decreased energy, sex drive, blood count and decreased bone strength. High prolactin also can lead to breast tenderness, enlargement and milk secretion in males.
High prolactin levels due to physiological reasons like pregnancy and lactation becomes normal on its own. Other causes for high prolactin like low thyroid hormones, kidney problems, chest wall problems, drug induced high prolactin will get normalised once these problems are addressed.
The usual normal range for serum prolactin is approximately 5 to 20 ng/mL (5 to 20 mcg/L). High prolactin due to secondary causes will cause mild to moderate increase in prolactin level (20 to 100 mcg/L). Micro prolactinomas (pituitary tumor less than 10 mm) causes moderate elevation in prolactin (50 to 200 mcg/L). Macro prolactinomas (Pituitary tumor more than 10 mm) will lead to very high levels of prolactin (>200 mcg/L).
Our medical endocrinologist will evaluate to find out the treatable cause for high prolactin levels. If secondary causes are found, that will be treated first before going for imaging like MRI. Most of the patients treated with this approach will have normal prolactin levels on follow up. Laboratory investigations for prolactin, other pituitary hormones, tests to rule out secondary causes and Macro prolactin (Condition in which prolactin levels will be high, but patients don’t require any treatment) can be done at MAGNA.
Treatment for high prolactin depends on the cause. If it’s due to physiological reason or secondary cause, the patient will not require any treatment other than treating the underlying disorder. If the patient has Prolactinoma or Idiopathic hyperprolactinemia ( When pituitary adenoma, macroprolactinemia and secondary causes are ruled out), they will require medical treatment with dopamine Agonist. Dopamine agonists include bromocriptine or Cabergoline.