Hyperprolactinemia: Treatment, Procedure, Cost and Side Effects

Hyperprolactinemia is a condition where there is an abnormally high level of the hormone prolactin in the blood. Prolactin is a hormone that is produced by the pituitary gland. Prolactin hormone controls lactation and development of breasts in pregnant women. Normal level of prolactin in females is <500 mlU/L and for males is less than 450 mlU/L. Increased prolactin levels in blood can cause irregular menstruation or complete stoppage of menstruation, sexual dysfunction, and even infertility in females. In males, increased prolactin levels can cause sexual dysfunction, decreased libido, erectile dysfunction, gynecomastia, and infertility.

Hyperprolactinemia can be caused by a number of different factors, both pathological and physiological. Physiologically, prolactin is secreted in the blood in increased amounts during pregnancy and in early post parturition period while breastfeeding is carried out. Pathologically, hyperprolactinemia can be caused by either a disinhibitory activity like a pituitary stalk compression due to a localized tumor, or due to increased production of prolactin caused by a type of pituitary gland tumor called prolactinoma. Some systemic diseases like renal failure, hypothyroidism, epileptic seizures, etc. can also cause hyperprolactinemia. A number of medications induce prolactinemia, especially those that reduce dopamine production or reception at the pituitary as dopamine is the natural antagonist to prolactin, keeping each other in balance.

Treatment of hyperprolactinemia target either the symptoms or the tumor if a tumor is the cause. Symptoms caused by hyperprolactinemia like amenorrhea, gynecomastia, etc. are treated as they appear. Medications causing hyperprolactinemia are best withdrawn if possible, if not they are to be supplemented by dopamine agoniststo balance prolactin levels. Radiation treatment can be prescribed in some cases. In cases where no response to dopamine agonists is visible, a trassphenoidal surgery to remove a pituitary tumor may be prescribed.

Treatment for hyperprolactinemia is directed towards the symptoms produced by hyperprolactinemia, or towards any tumor growths causing the condition. Dopamine agonists have been shown to be effective in decreasing prolactin secretion. Symptoms caused by hyperprolactinemia include hypothyroidism and osteoporosis among others. These conditions need to be treated individually. In cases where medications cause hyperprolactinemia, withdrawal of the medication is advised if possible. In tumors that grow rapidly and uncontrollably, radiation therapy is prescribed. Surgical treatment is advised when there is no response to dopamine agonists or medicine resistant tumors.

People showing symptoms of consistently high prolactin levels in blood show some typical symptoms in both males and females. These include irregular or absent menstruation in females, sexual dysfunction in both males and females, and gynecomastia in males. Symptoms in males are not as easily detectable as decreased libido is not easily attributable to hyperprolactinemia and gynecomastia can occur due to a number of reasons. A tumor causing the problem can apply pressure on the optic chiasm, causing headaches and consistent vision problems. Patients showing symptoms of hypothyroidism and osteoporosis need to be checked for hyperprolactinemia in case increased prolactin is the cause of these symptoms. All patients with increased prolactin levels are eligible for treatment with dopamine agonists. For those with very quickly growing tumors, radiation therapy is advised. For those who do not respond to medicines or radiations, surgical treatment is advised.

Hyperprolactinemia is normally caused during pregnancy and during breastfeeding, hence pregnant women and breastfeeding women do not need treatment. Mental stress can also cause an increase in prolactin levels in blood and hence do not need treatment as these levels subside soon.

Side effects of the treatment depend upon the treatment approach undertaken. If medications cause hyperprolactinemia and these medicines are withdrawn, the original disease for which these medications were prescribed remain untreated. Radiation therapy is associated with a number of side effects including fatigue, nausea, weakness, etc.

Recovery from hyperprolactinemia usually depends on the treatment approach undertaken. Even after blood prolactin levels come down, other conditions caused due to increased prolactin levels also take time to recover.

Successful recovery from hyperprolactinemia needs to be followed up with regular checkups, a healthy diet and an active lifestyle.

Recovery from hyperprolactinemia usually depends on the treatment approach undertaken. Even after blood prolactin levels come down, other conditions caused due to increased prolactin levels also take time to recover.

Treatment for hyperprolactinemia ranges between Rs. 50 for a thyroid hormone replacement therapy, going up to Rs. 50 lakhs for tumor surgeries.

Treatment with dopamine antagonists are usually not permanent and need to be followed up regularly. Other methods like surgery to remove tumors are usually permanent as it targets the cause of increased prolactin levels if surgical tumor removal is successful.