Hyperprolactinemia means the presence of abnormally high values of
prolactin. It's the most common clinical hypothalamic-hypophysis disorder.
Amenorrhea and
anovulation are the most usual clinical findings but we can find milder alterations of gonadal function as
oligomenorrhea or luteal phase alterations. Galattorrhea appears in approx 30% of patients, but its presence in women with ovulation disorders is highly suggestive of
hyperprolactinemia. Subjects with primary
amenorrhea and
delayed puberty can present
hyperprolactinemia. Male
hyperprolactinemia can cause
hypogonadism (decreased
testosterone levels), libido decrease,
infertility due
oligospermia and
gynecomastia while
galactorrhea rarely occurs. Accurate anamnesis is very important for a correct diagnosis. It's necessary to exclude pregnancy and
primary hypothyroidism. The use of many drugs can be associated with
hyperprolactinemia but the most common causes are idiopathic
hyperprolactinemia and hypophysis secreting
adenoma. Diagnostic examinations are: PRL, FT3, FT4, TSH in case of
hypothyroidism,
testosterone in men, eventually sampling GH, IGF,
ACTH,
cortisol, free urinary
cortisol. Dynamic tests are used just for idiopathic
hyperprolactinemia, but today their meaning is widely discussed. CAT and MNR are necessary to observe hypotalamus, hypophysis and optic chiasm. Twenty years ago the sole option for
prolactinoma patients was adenomectomy, today idiopathic
hyperprolactinemia can be treated with drugs, while
prolactinoma can be treated with a pharmacological, surgical or radiological
therapy.