Majumdar, A., & Mangal, N. S. (2013). Hyperprolactinemia. Journal of human reproductive sciences, 6(3), 168-75. https://doi.org/10.4103/0974-1208.121400
Majumdar A, Mangal NS. Hyperprolactinemia. Journal of human reproductive sciences. 2013;6(3):168-75. doi:10.4103/0974-1208.121400
Majumdar, Abha, and Nisha Sharma Mangal. "Hyperprolactinemia." Journal of human reproductive sciences, vol. 6, no. 3, 2013, pp. 168-75.
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RRM Academy Synopsis
Hyperprolactinemia most commonly appears as an ovulation problem
A 2013 narrative review reports that pathological hyperprolactinemia (high prolactin) most commonly shows up as an ovulation problem. The review covers causes, symptoms, tests and treatment for women and men. It also describes macroprolactin, a form of the hormone that lab tests count but that has little or no biological effect.
Study at a glance, narrative review of women and men: High prolactin most commonly shows up as an ovulation problem. Source: Majumdar A et al., 2013, PMID 24347930.
Key Findings
Prevalence is 0.4% among unselected adults. Among women with reproductive diseases the range is 9-17%, and 9% of women with adult onset amenorrhea have it.
Prolactinomas make up 25-30% of functioning pituitary tumors. The review names them the leading cause of long-lasting hyperprolactinemia.
Women with prolonged low estrogen from hyperprolactinemia have spinal bone mineral density lower by approximately 25%. Normalizing prolactin levels does not necessarily restore it.
The review states that dopamine agonist medication alone brings ovulation in approximately 80-90% of women when hyperprolactinemia is the only cause of missed ovulation.
After bromocriptine treatment stops, prolactin rises again in 75% of patients. No clinical or laboratory measure identifies who will keep the benefit.
Interpretation
This narrative review by two authors addresses hyperprolactinemia in both women and men, with most detail given to women. The prevalence figures, the tumor share and the ovulation rate with treatment show a common, treatable cause of missed ovulation. The findings support larger studies on bone density recovery and on relapse after treatment stops.
RRM Context
The review closes by advising that a raised prolactin result be shown to matter before treatment begins. Restorative reproductive medicine follows the same order: find the cause first. Absent or irregular ovulation has a reason, and the review names several, such as pituitary tumors, medications and an underactive thyroid. Cycle charting can record the irregular cycles.
Our editorial summary of this paper, not the article's abstract.
Abstract
Prolactin (PRL) is an anterior pituitary hormone which has its principle physiological action in initiation and maintenance of lactation. In human reproduction, pathological hyperprolactinemia most commonly presents as an ovulatory disorder and is often associated with secondary amenorrhea or oligomenorrhea. Galactorrhea, a typical symptom of hyperprolactinemia, occurs in less than half the cases. Out of the causes of hyperprolactinemia, pituitary tumors may be responsible for almost 50% of cases and need to be investigated especially in the absence of history of drug induced hyperprolactinemia. In women with hyperprolactinemic amenorrhea one important consequence of estrogen deficiency is osteoporosis, which deserves specific therapeutic consideration. Problem in diagnosing and treating hyperprolactinemia is the occurrence of the 'big big molecule of prolactin' that is biologically inactive (called macroprolactinemia), but detected by the same radioimmunoassay as the biologically active prolactin. This may explain many cases of very high prolactin levels sometimes found in normally ovulating women and do not require any treatment. Dopamine agonist is the mainstay of treatment. However, presence of a pituitary macroadenoma may require surgical or radiological management.
