Hyperprolactinemia

Hyperprolactinemia occurs when the pituitary gland produces abnormally high levels of prolactin, a hormone that normally stimulates milk production after childbirth. Elevated prolactin can disrupt the hypothalamic–pituitary–gonadal axis, leading to menstrual disturbances, infertility, decreased libido, and galactorrhea (milky nipple discharge) in women. In men, it may cause erectile dysfunction, low testosterone, reduced body hair, and sometimes breast enlargement.

Common causes include prolactin?secreting pituitary tumors (prolactinomas), hypothyroidism, certain medications (such as antipsychotics and some antidepressants), chronic kidney disease, and chest?wall irritation. Mild or physiological hyperprolactinemia can also occur during pregnancy, breastfeeding, stress, or sleep.

Diagnosis relies on blood tests to confirm raised prolactin, with further imaging (MRI) if a tumor is suspected, and evaluation of thyroid and kidney function. First?line treatment usually involves dopamine agonists like cabergoline or bromocriptine, which normalize prolactin, shrink tumors, and restore fertility in most cases. In rare, refractory cases, surgery or radiotherapy may be considered.