Common causes of hyperprolactinemia

The abnormal increase of serum prolactin (PRL) to greater than 1.14nmol/L (25up/L) is called hyperprolactinemia. Hyperprolactinemia can be divided into physiological and pathological. The former is a normal phenomenon and does not harm the patient; the latter refers to the abnormal increase of prolactin, which is harmful to the patient. So, what causes this disease? Please see the following introduction for details.

The main causes of hyperprolactinemia are:

① Physiological factors: pregnancy, postpartum and breastfeeding, eating, emotional stress and strenuous exercise can all cause hyperprolactinemia.

② Drug factors: Drug factors are the most common cause of hyperprolactinemia. According to reports, about 50% of women treated with antipsychotic drugs have lactation. The drug most likely to cause lactation is chlorpromazine hydrochloride. About 75% to 80% of users may experience lactation and amenorrhea. Long-term use of chlorpromazine, meprobamate and diazepam can also induce lactation. Among antihypertensive drugs, reserpine and methyldopa can cause increased prolactin or lactation. Anesthetics such as morphine and heroin can also induce it. In addition, steroid hormones including synthetic estrogen and estrogen-progesterone combination, metoclopramide and other drugs can all lead to hyperprolactinemia.

③Pathological factors: About 30% of patients with primary hypothyroidism have elevated prolactin levels and 2% to 5% have lactation. 60% to 70% of pituitary tumors are prolactinomas, and patients often have both lactation and amenorrhea. Prolactin adenoma is a common cause of pathological hyperprolactinemia. Chronic renal failure, local irritation such as thoracic surgery, trauma, herpes zoster or chronic breast irritation can cause hyperprolactinemia. Hypothalamic disorders such as hypothalamic tumors, degeneration, granulomas, vascular or infectious lesions can all cause hyperprolactinemia.

④ Functional or idiopathic factors: Idiopathic hyperprolactinemia is caused by abnormal regulation of pituitary lactocytes by the hypothalamus.