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Hyperprolactinaemic anovulation 

Hyperprolactinaemic anovulation
Chapter:
Hyperprolactinaemic anovulation
Author(s):

Julian R. E. Davis

DOI:
10.1093/med/9780199235292.003.0846
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date: 13 November 2019

Prolactin is a polypeptide hormone, named from its well-known effects to promote lactation. It is essential for successful reproduction in man and mammals, although it is known to have a wide variety of nonreproductive effects whose clinical significance remains uncertain.

Hyperprolactinaemia, reflecting sustained overproduction of lactin by the pituitary, is relatively common in the population. The commonest cause is the use of drugs that have dopamine D2 receptor antagonist activity (e.g. antipsychotic agents such as phenothiazines), pregnancy and lactation are the commonest physiological causes, and short-term acute stress, such as the anxiety provoked by blood sampling, is also a frequent cause of transient rises in serum prolactin that may be misinterpreted and necessitate a second confirmatory blood sample. Pathological pituitary causes of hyperprolactinaemia may reflect a functioning pituitary prolactinoma, but in many cases no adenoma is detectable on scanning, in which case the condition is termed idiopathic or nontumoral hyperprolactinaemia.

The typical clinical features that suggest hyperprolactinaemia are those of galactorrhoea and oligo-/amenorrhoea. Weight gain has been reported in hyperprolactinaemic women, as has insulin resistance. Serum prolactin levels are readily measured by most clinical biochemistry laboratories, and prolactin levels should be measured on more than one occasion, with persistent unexplained hyperprolactinaemia requiring evaluation.

Patients with hyperprolactinaemia may require treatment for various reasons, including restoration of ovulatory function, maintenance of adequate oestrogenization, suppression of galactorrhoea, or reduction in size of a mass lesion. Depending on the presentation and underlying cause, there are several treatment options; the main current treatment option is dopamine agonist therapy, surgery and (rarely) radiotherapy are also used in the treatment of prolactinomas.

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