Overview

Hyperprolactinaemia means abnormally elevated prolactin when not pregnant or breastfeeding. Excess prolactin suppresses FSH and LH, causing irregular or absent periods and infertility in women, and reduced testosterone and fertility in men. It is one of the most treatable hormonal causes of infertility.

Symptoms

Women: Irregular or absent periods; milky nipple discharge (galactorrhoea); difficulty conceiving; vaginal dryness; reduced libido; headaches or visual disturbance if caused by a large tumour.
Men: Reduced libido and erectile dysfunction; infertility; breast tissue enlargement.

Causes

• Prolactinoma — most common; small benign pituitary tumour
• Hypothyroidism
• Medications — antipsychotics, antidepressants, antiemetics
• Chronic kidney or liver disease
• Idiopathic — mild elevation with no identifiable cause

Diagnosis

• Serum prolactin — fasting blood test
• Thyroid function tests
• Pregnancy test
• Pituitary MRI — when significantly elevated
• Visual field assessment — for large tumours

Treatment

• Cabergoline or bromocriptine — first-line; lowers prolactin, shrinks prolactinomas, restores ovulation; cabergoline preferred
• Treating underlying cause — hypothyroidism or drug-induced elevation
• Surgery — for tumours not responding to medication

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