Abstract
Hyperprolactinaemia is one of the most common problems in clinical endocrinology. It relates with various aetiologies (physiological, pharmacological, pathological), the clarification of which requires careful history taking and clinical assessment. Analytical issues (presence of macroprolactin or of the hook effect) need to be taken into account when interpreting the prolactin values. Medications and sellar/parasellar masses (prolactin secreting or acting through “stalk effect”) are the most common causes of pathological hyperprolactinaemia. Hypogonadism and galactorrhoea are well-recognized manifestations of prolactin excess, although its implications on bone health, metabolism and immune system are also expanding. Treatment mainly aims at restoration and maintenance of normal gonadal function/fertility, and prevention of osteoporosis; further specific management strategies depend on the underlying cause. In this review, we provide an update on the diagnostic and management approaches for the patient with hyperprolactinaemia and on the current data looking at the impact of high prolactin on metabolism, cardiovascular and immune systems.
Highlights
Prolactin (PRL) was first discovered between the late 1920s and early 1930s after different authors independently demonstrated lobular-alveolar development and lactation in rabbits after injection of an anterior pituitary extracts [1,2]
It has been suggested that approximately 40% of cases of primary hypothyroidism are associated with hyperprolactinaemia [47,48] caused by stimulation of lactotroph cells from the increased thyrotropin-releasing hormone (TRH) levels [9]
Hyperprolactinaemia is a biochemical diagnosis with a broad range of aetiologies
Summary
Prolactin (PRL) was first discovered between the late 1920s and early 1930s after different authors independently demonstrated lobular-alveolar development and lactation in rabbits after injection of an anterior pituitary extracts [1,2]. The lactotrophic and reproductive actions of PRL are well established, and in recent years, there has been enhanced understanding of the many other biological effects of extra pituitary PRL in humans [9,13] In women, it is involved in follicular development and maintenance of the corpus luteum, and acts on the mammary gland to induce and maintain lactation [14]. PRL produced from lymphocytes and hematopoietic cells has been postulated to be involved in the immune response to stress [8,9,13,15]; its action appears to be dose-related, with immune stimulation at modest and inhibition at high levels [9] It has varying effects on bone during development and reproduction; in the foetus, it promotes bone growth and mineralization, whereas during pregnancy, it contributes to the accelerated bone resorption providing micronutrients to the foetus [16]. Animal models have suggested metabolic actions including stimulating insulin release, beta-cell proliferation, and adipogenesis [10], whereas in the central nervous system, PRL promotes remyelination [9,17]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
