Prolactin is a hormone produced by the pituitary gland that causes breast development in women and milk production in pregnant women. Prolactin does not have known biological function in men. Serum prolactin increases normally throughout pregnancy, reaching its highest level at the time of delivery. Prolactin also increases during nipple stimulation and breastfeeding. Physical and emotional stress can cause serum levels of prolactin to rise as well. In these cases, however, the increase is usually modest and usually do not exceed normal age and gender ranges. Other causes of elevated serum prolactin levels can lead to hyperprolactinemia, which is a higher than normal level of serum prolactin.
Normal Ranges for prolactin:
|
Adult Male |
2.0-18.0 |
ng/mL |
|
Adult Female |
|
|
|
Non-Pregnant |
3.0-30.0 |
ng/mL |
|
Pregnant |
10.0-209.0 |
ng/mL |
|
Postmenopausal |
2.0-20.0 |
ng/mL |
Sources:
http://www.questdiagnostics.com/testcenter/TestDetail.action?ntc=746
https://www.uptodate.com/contents/causes-of-hyperprolactinemia
https://www.uptodate.com/contents/clinical-manifestations-and-evaluation-of-hyperprolactinemia
https://emedicine.medscape.com/article/2089400-overview#a4
https://emedicine.medscape.com/article/124526-clinical#b5
Stages of Puberty (Tanner Stages)
|
|
Female Observed |
Male Observed |
|
Stage I |
3.6.12.0 ng/mL |
≤10.0 ng/mL |
|
Stage II-III |
2.6-18.0 ng/mL |
≤6.1 ng/mL |
|
Stage IV-V |
3.2-20.0 ng/mL |
2.8-11.0 ng/mL |
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Note: Serum prolactin levels naturally fluctuate throughout the menstrual cycle and can rise in response to various physiological stimuli, including sleep, physical exercise, nipple stimulation, sexual activity, low blood sugar (hypoglycemia), pregnancy, stress, and surgery.
Hyperprolactinemia means you have higher-than-normal levels of prolactin in your blood. The most common cause is a prolactinoma, a benign (noncancerous) tumor in your pituitary gland. Certain health conditions and medications can also cause hyperprolactinemia.
What is hyperprolactinemia?
Hyperprolactinemia is a treatable condition in which you have higher-than-normal levels of prolactin, a hormone, in your blood. While it isn’t life-threatening, hyperprolactinemia can cause infertility and other issues.
What is prolactin?
Prolactin (also known as lactotropin) is a hormone that’s mainly responsible for the development of mammary glands within breast tissue, milk production and lactation. It also contributes to several bodily processes and functions. Your pituitary gland is mainly responsible for producing and secreting prolactin, but the following body systems and parts are also capable of producing prolactin:
Central nervous system.
Immune system.
Uterus.
Mammary glands.
Prolactin levels are normally low in males and non-lactating and non-pregnant people. They’re normally elevated in people who are pregnant or breastfeeding (chestfeeding).
In general, the normal values for prolactin include:
Males: Less than 20 ng/mL (nanograms per milliliter).
Females who are not pregnant or chestfeeding: less than 25 ng/mL.
For people who are pregnant or chestfeeding: 80 to 400 ng/mL.
Who does hyperprolactinemia affect?
Hyperprolactinemia most commonly affects people under the age of 40. Females are more likely to have hyperprolactinemia than people males. Hyperprolactinemia is rare in children.
How common is hyperprolactinemia?
Hyperprolactinemia affects less than 1% of the general population. The most common cause of hyperprolactinemia is a prolactinoma, a benign (noncancerous) prolactin-releasing tumor. Prolactinoma rates are about 30 per 100,000 in females and 10 per 100,000 in males.
What is the difference between hyperprolactinemia and prolactinoma?
A prolactinoma is a benign (noncancerous) tumor that forms in your pituitary gland and causes excess production of prolactin.
Hyperprolactinemia happens when you have higher-than-normal levels of prolactin in your blood in general. While a prolactinoma can cause hyperprolactinemia, it’s not the sole cause of it. Other situations, such as certain medications, can cause hyperprolactinemia as well.
Symptoms and Causes
What are the signs and symptoms of hyperprolactinemia?
Some people who have hyperprolactinemia have very mild or no symptoms (are asymptomatic).
For anyone, hyperprolactinemia can cause the following symptoms:
Infertility.
Loss of interest in sex.
Low bone mass.
Milky discharge from your nipples when not pregnant or chestfeeding (galactorrhea).
For women, symptoms of hyperprolactinemia include:
Changes in menstruation not related to menopause, such as irregular periods (menstruation) or no periods (amenorrhea).
Pain or discomfort during penetrative sex due to vaginal dryness.
For men, common symptoms of hyperprolactinemia include:
Erectile dysfunction (ED).
Low levels of testosterone.
Enlarged breast tissue (gynecomastia).
What causes hyperprolactinemia?
Several factors and conditions can cause hyperprolactinemia, including:
Prolactinoma (most common cause).
Certain medications.
Certain health conditions.
Other pituitary gland tumors.
Sometimes, no cause of hyperprolactinemia can be found. This is known as idiopathic hyperprolactinemia. It usually goes away without treatment after several months.
Prolactinomas
A prolactinoma is the most common cause of hyperprolactinemia. A prolactinoma is a benign (noncancerous) tumor that forms in your pituitary gland and causes excess production of prolactin.
In addition to the symptoms of hyperprolactinemia, you may experience the following symptoms if you have a prolactinoma:
Headaches.
Nausea and/or vomiting.
Vision changes, such as double vision or decreased peripheral vision.
Sinus pain or pressure.
Problems with your sense of smell.
Medications
The brain chemical dopamine helps suppress the production of prolactin in your body. Any medication that affects the production or use of dopamine in your body can make your prolactin levels rise.
Medications that can increase prolactin levels in your blood include:
High blood pressure medications, such as calcium channel blockers and methyldopa.
Certain antipsychotic medications, such as risperidone and haloperidol.
Medications that treat nausea and vomiting.
Medications that treat heartburn and gastroesophageal reflux disease (GERD).
Birth control pills.
Pain relievers that contain opioids.
Medications that treat menopause symptoms, such as estrogen therapy.
If you have high prolactin levels due to a medication, your levels will usually return to normal three to four days after you stop taking the medication. Never stop taking a prescribed medication unless your healthcare provider has told you to do so.
Health conditions
Health conditions other than a prolactinoma that may increase prolactin levels in your blood include:
Hypothyroidism (underactive thyroid).
Kidney disease.
Shingles, especially if the rash or blisters are on your chest.
Chest wall injuries, such as fractured ribs, fractured sternum (breastbone) and bruising on your lungs.
Polycystic ovary syndrome (PCOS).
Cushing’s syndrome.
Nelson syndrome.
Other pituitary gland tumors
Large tumors (other than prolactinomas) located in or near your pituitary gland may cause hyperprolactinemia. This is usually because the tumor prevents dopamine, which suppresses prolactin, from reaching your pituitary gland.
Radiation treatment for tumors on or near your pituitary gland may also cause hyperprolactinemia.
Diagnosis and Tests
How is hyperprolactinemia diagnosed?
If you experience signs and symptoms of hyperprolactinemia, your healthcare provider will likely order a prolactin (PRL) blood test for you.
If your results show that you have hyperprolactinemia, the next step will be to determine the cause. Your provider may have you undergo additional testing, such as other blood tests and imaging tests.
Management and Treatment
How is hyperprolactinemia treated?
The treatment for hyperprolactinemia depends on its cause. Some people who have high prolactin levels but have few or no symptoms don’t need treatment.
Treatment options for prolactinomas (the most common cause of hyperprolactinemia) include:
Medication: Medications called dopamine agonists regulate your prolactin levels and are very effective in shrinking prolactinoma tumors. This is the most common form of treatment for prolactinomas.
Surgery: If medication isn’t working to shrink your prolactinoma, you may need to have surgery to remove it.
Radiation therapy: This is a rare third option for treating prolactinomas if medications and/or surgery do not work to reduce your prolactin levels.
Hypothyroidism, which can cause hyperprolactinemia, is treated with synthetic thyroid hormone, which should also bring prolactin levels back to normal.
If prescription medications are causing your hyperprolactinemia, your healthcare provider may prescribe you other similar types of medications that don’t increase your prolactin levels or don’t increase them as much.
Prevention
Can I prevent hyperprolactinemia?
Unfortunately, there’s nothing you can do to prevent hyperprolactinemia.
The only known risk factor for developing a prolactinoma, the most common cause of hyperprolactinemia, is having an inherited (passed through the family) condition called multiple endocrine neoplasia (MEN) type 1.
If you have a first-degree relative (sibling or parent) who has this condition, you may want to go through genetic testing to check to see if you have it as well. This may help screen for and catch a prolactinoma in its early phases.
Outlook / Prognosis
What is the outlook (prognosis) for hyperprolactinemia?
The prognosis (outlook) for hyperprolactinemia is generally good. Treatment for prolactinomas, the most common cause of hyperprolactinemia, is usually effective.
Although hyperprolactinemia is not life-threatening, it can cause certain issues such as infertility and irregular periods. Because of this, it’s important to receive treatment if you have hyperprolactinemia.
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Low levels of prolactin are primarily a problem for women during development and around pregnancy. It can interfere with breast development and breastfeeding. Some evidence suggests that low prolactin levels may also interfere with male fertility.
Some specific causes of low prolactin are:
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17-Hydroxypregnenolone, MS (female), 17-Hydroxyprogesterone (female), 17-OH Progesterone, 5 Alhpa-Dihydrotestosterone (male), ACTH, Plasma, ADH, Aldos/Renin Ratio, Aldosterone, Aldosterone/Plasma Renin Activity Ratio, Anti-Mullerian Hormone (AMH), C-Telopeptide, Serum, Calcitonin, Serum, Cortisol - ACTH (Cortrosyn) Stimulation Test, Cortisol - AM (Serum), Cortisol, Serum, Cortisol-Binding Globulin (CBG), DHEA, Unconjugated, DHEA-S : Cortisol Ratio, DHEAS (Serum), DHT, Free, DHT, Percent Free Dialysis, Estradiol, Estradiol (male), Estradiol, Ultrasensitive, LC/MS, Estriol, Serum, Estrogens, Total (female), Estrogens, Total (male), Estrone Sulfate, Estrone, Serum (Female), Estrone, Serum (Male), Free Cortisol, Serum, Free Estradiol, Percent, Free Estradiol, Serum, Glucagon, Gonadotropin Releasing Hormone (GnRH), Growth Hormone, Human Chorionic Gonadotropin (hCG), Total, IA-2 Autoantibodies, IGF Binding Protein 1 (IGFBP 1), IGF Binding Protein 3 (IGFBP 3), IGF-BP3, Leptin, Luteinizing Hormone, Human (hLH), Pregnenolone (male), Progesterone (male), Progesterone (Serum), Prolactin, Renin Activity, Plasma, Total Testosterone (Female/ng/mL)
