Clinical Information

Prolactin is secreted by the anterior pituitary gland under negative control by dopamine, which is secreted by the hypothalamus. The only physiological function of prolactin is the stimulation of milk production. In normal individuals, the prolactin concentration in blood rises in response to physiologic stimuli such as nipple stimulation, sleep, exercise, sexual intercourse, and hypoglycemia. Certain medications, (eg, phenothiazines, metoclopramide, risperidone, selective serotonin reuptake inhibitors, estrogens, verapamil) may also cause hyperprolactinemia. Pathologic causes of hyperprolactinemia include prolactin-secreting pituitary adenoma (prolactinoma), diseases of the hypothalamus, primary hypothyroidism, section compression of the pituitary stalk, chest wall lesions, renal failure, and ectopic tumors.

Hyperprolactinemia may also be caused by the presence of a high-molecular-mass complex of prolactin called macroprolactin (typically due to prolactin bound to immunoglobulin). In this situation, the patient is asymptomatic. Hyperprolactinemia attributable to macroprolactin is a frequent cause of misdiagnosis and mismanagement of patients. Macroprolactin should be considered if, in the presence of elevated prolactin levels, signs and symptoms of hyperprolactinemia are absent, or pituitary imaging studies are not informative.