What is hyperprolactinemia?
Why you should care and how I self-diagnosed while going through pharmacy school.
Hyperprolactinemia is a medical condition where you have excess prolactin circulating through your blood. What is prolactin you say? It is a hormone produced and excreted via the pituitary gland and its main responsibility is the stimulation of breast milk production after childbirth. However, prolactin can also impact sex hormones, testosterone in males and estrogen in females. This is a very rare condition only happening in less than 1% of the general population, so imagine my surprise when I actually confirmed I had it.
The most common cause is a benign tumor called prolactinoma that grows on the pituitary gland. Prolactinomas produce large amounts of prolactin causing a hormone imbalance. These tumors vary in size, therefore there is a variation in symptoms. Taking certain drugs may also cause this condition. Some of the medication classes that increase prolactin levels include antipsychotics, opiates, antihypertensive agents, protease inhibitors, and antidepressants. But we cannot stop there, there are conditions that might also increase prolactin levels. As expected, these conditions include pregnancy and lactation, which is natural and no cause for concern. On the less obvious side there are injuries or conditions that affect the chest wall, chronic renal and hepatic disease, hypothyroidism, and other types of tumor affecting the pituitary gland that also increase prolactin levels. Hyperprolactinemia may also be idiopathic.
Maybe you are asking yourself why it is so important to talk about a condition that most likely will not affect you. Well, I believe that some people are actually going about their lives right now without knowing they have this condition and that the percentage of people that might have it, is actually higher than what is reported. Take my story for example, I have been in a relationship with my partner for over 10 years and we had been trying to conceive for at least the last 3 years without success. How does this relate to hyperprolactinemia? Next, we are going to talk about some of the symptoms and consequences of having this condition and it will all be clear.
Symptoms of this condition vary from almost undetectable to severe and are different for males and females. Bone loss, decreased sex drive and infertility may affect both sexes. Women may experience absence of menstruation, irregular menstruation, vaginal dryness, and production of milk while not pregnant or nursing. Men may present with enlarged breasts, erectile dysfunction, decreased muscle mass and body hair. Larger tumors may also cause headaches and vision changes. So, how exactly did I diagnose myself?
There I was, sitting in one of my pharmacology classes learning about this condition I had never heard of before and checking all the symptoms’ boxes. Did I have this rare condition? Was I imagining things? I made the decision to ask my doctor for blood work. A blood test is the first step to diagnosing hyperprolactinemia because it can easily measure the prolactin levels in the blood. Then, I got my results back. Imagine my surprise when my doctor told me my levels were almost four times higher than the upper limit of normal. What now? My doctor explained to me that the next step was to go for an MRI and see if there is a tumor. After my MRI was completed, it was concluded that my hyperprolactinemia was either caused by a very small tumor that could not be seen or it was idiopathic.
Now we move on to understanding the treatments available. The most common one is taking a dopamine agonist, followed by surgery, then radiation (which is rarely used). In my case, there was no visible tumor to be surgically removed so I started taking cabergoline, a dopamine agonist. This class of medication decreases the synthesis and release of prolactin and can also aid in shrinking a prolactinoma if one is present. Right now, you might be wondering if the treatment worked. And it did, like magic, within two weeks my levels were within the normal range.
Finally, I will explain the reason why I was inspired to write this article. First of all, I cannot tell you how many times I had to explain this condition to other healthcare professionals. If most healthcare professionals are unaware of this condition, I imagine a lay person will be even less likely to know about it. Secondly, after a couple years of frustration and worrying about not being able to conceive my partner and I are finally expecting our first child. I am now 27 weeks pregnant and as happy as I can be. Additionally, I am thankful I was paying attention to that lecture and I hope there are more people out there that may benefit from this article and brand-new knowledge regarding this rare condition.
Thank you for reading!
Sincerely,
Larissa Martins.
