Hyperprolactinaemia in Men: A Review of Clinical Presentation, Diagnosis and Treatment

Abstract

Hyperprolactinaemia is one of the commonest non-diabetes endocrine disorder seen by Endocrinologists. Prolactin is a polypeptide hormone secreted by the anterior pituitary gland. Its main physiological role is in milk production. Hyperprolactinaemia is more common among females and there is paucity of literature on hyperprolactinaemia among men. The causes of hyperprolactinaemia include physiological causes (such as sleep), drugs, sellar masses, including prolactinoma, other endocrine disorders such as hypothyroidism. The clinical presentation in males results from the disruption of the hypothalamus-pituitary-testicular axis and mass effect. It is an important and often overlooked cause of hypogonadism in males. Men usually present with macroprolactinomas with accompanying symptoms of mass effect such as visual impairment. Diagnosis of hyperprolactinaemia is made from relevant symptoms and signs and confirmed by immunoassay of the serum prolactin. Other relevant investigations need to be done to identify the potential causes of the disorder. Magnetic resonance imaging is the radiological investigation of choice to visualize the pituitary. Treatment of hyperprolactinaemia in males is dependent on aetiology and symptomatology. Some medications may need to be stopped or changed. Pharmacotherapy with dopamine agonists is the first line treatment of prolactinomas. Symptomatic cases of prolactinomas with drug resistance or drug intolerance are referred for surgery or radiotherapy