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Hyperprolactinaemia (also spelled hyperprolactinemia) is a condition characterized by abnormally high levels of prolactin in the blood. In women, normal prolactin levels average to about 13 ng/mL, while in men, they average 5 ng/mL. The upper normal limit of serum prolactin is typically between 15 and 25 ng/mL for both genders. [1]
The Journal of Human Lactation is a peer-reviewed medical journal that covers research on human lactation and breastfeeding behavior. The editor-in-chief is Joan E. Dodgson (Saint Louis University). The journal was established in 1985 and is published by SAGE Publications. It is the official journal of the International Lactation Consultant ...
The persistent hypogonadism associated with hyperprolactinemia can lead to osteoporosis. Treatment significantly improves the patient's quality of life. If the goal is to treat hypogonadism only, patients with idiopathic hyperprolactinemia or microadenoma can be treated with estrogen replacement therapy and prolactin levels can be monitored.
High levels of prolactin during pregnancy and breastfeeding also increase insulin resistance, increase growth factor levels (IGF-1) and modify lipid metabolism in preparation for breastfeeding. During lactation, prolactin is the main factor maintaining tight junctions of the ductal epithelium and regulating milk production through osmotic balance.
There are currently two different mechanisms described in literatures explaining the cause of hyperprolactinemia in neonates. One mechanism states that hyperprolactinemia in neonates results from the decline of maternally transferred estrogen after birth. Decreased estrogen increases production of prolactin which increases milk production. [3]
Prolactin has a wide variety of effects. It stimulates the mammary glands to produce milk (): increased serum concentrations of prolactin during pregnancy cause enlargement of the mammary glands and prepare for milk production, which normally starts when levels of progesterone fall by the end of pregnancy and a suckling stimulus is present.
Galactorrhea can also be caused by antipsychotics that cause hyperprolactinemia by blocking dopamine receptors responsible for control of prolactin release. Of these, risperidone is the most notorious for causing this complication. [5] Case reports suggest proton-pump inhibitors have been shown to cause galactorrhea.
Prolactin inhibitors are mainly used to treat hyperprolactinemia (high prolactin levels). [1] Agonists of the dopamine D 2 receptor such as bromocriptine and cabergoline are able to strongly suppress pituitary prolactin secretion and thereby decrease circulating prolactin levels, and so are most commonly used as prolactin inhibitors. [1]