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Hyperprolactinemia CausesAka: Galactorrhea causes

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  1. See Also
    1. Hyperprolactinemia
    2. Galactorrhea
  2. Causes: Timing of increases
    1. Very brief increases in Prolactin (hours)
      1. Meals
      2. Clozapine
      3. Generalized Tonic-Clonic Seizure
      4. Sexual intercourse
    2. Transient increase in Prolactin levels (days to weeks)
      1. First-generation Antipsychotic medications (e.g. Haloperidol)
      2. Second-generation Antipsychotic medications (except Clozapine)
      3. Recent Alcohol or nicotine use
    3. Sustained increase in Prolactin levels (weeks to months)
      1. Exogenous Estrogen
      2. Pregnancy
      3. Narcotics
      4. Chronic Renal Failure
      5. Cirrhosis
      6. Prolactinoma
    4. References
      1. Naus (2009) Federal Practitioner p. 44-9
      2. Haddad (2001) J Psychopharmacol 15(4):293
  3. Causes: Physiologic
    1. Breast stimulation
    2. Sexual Intercourse
    3. Eating or dehydration
    4. Exercise
    5. Sleep
    6. Stress
    7. Pregnancy or Puerperium
      1. Resolves within 6 months postpartum
    8. Neonatal Galactorrhea (Witch's Milk)
      1. Resolves in first 2 months of life
  4. Causes: Medications
    1. See Medication Causes of Hyperprolactinemia
  5. Causes: Non-Neoplastic
    1. Afferent Neural Stimulation
      1. Breast
        1. Chronic Breast abscess
        2. Excessive nipple or breast manipulation
          1. Irritating clothes
          2. Ill-fitting brassieres
      2. Chest Wall and Skin
        1. Herpes Zoster
        2. Mastectomy or other breast surgery
        3. Thoracotomy
      3. Spinal Cord tumor, injury or surgery
        1. Syringomyelia
        2. Tabes dorsalis
    2. Endocrine
      1. Adrenal adenoma or tumor
      2. Hypothyroidism
      3. Ovarian tumor
      4. Polycystic Ovary Disease
    3. Prolactin Inhibiting Factor (PIF) synthesis Inhibition
      1. Hypothalamic cause
      2. Cerebrovascular Accident (Infarction)
      3. Infiltrative Disease
        1. Encephalitis or post-Encephalitis
        2. Hemochromatosis
        3. Sarcoidosis
        4. Tuberculosis
        5. Schistosomiasis
        6. Schuller-Christian Disease
      4. Irradiation
      5. Pseudocyesis
      6. Parkinson's Disease
    4. Prolactin Inhibiting Factor (PIF) transport interrupted
      1. Pituitary stalk section interrupted
      2. Pituitary Stalk compression
        1. Cerebral Aneurysm
        2. Cerebral cyst
        3. Empty sella syndrome
        4. Pseudotumor Cerebri
    5. Other non-neoplastic causes
      1. Acute Intermittent porphyria
      2. Hepatic Cirrhosis
      3. Chronic Renal Failure
      4. Multiple Sclerosis
  6. Causes: Neoplastic
    1. Prolactin Inhibiting Factor (PIF) synthesis inhibition
      1. Hypothalamic Tumors
        1. Primary: Craniopharyngioma
        2. Metastases
      2. Pineal Tumors (Primary or metastatic)
    2. Prolactin Inhibiting Factor (PIF) transport interrupted
      1. Pituitary stalk compression
        1. Hypothalamic tumor
        2. Pituitary tumor
    3. Prolactin-secreting tumors
      1. Pituitary tumors
        1. Acromegaly
        2. Cushing's Disease
        3. Nelson Disease
        4. Prolactin-secreting pituitary tumor
      2. Ectopic tumor production
        1. Breast Cancer
        2. Bronchogenic Carcinoma
        3. Hypernephroma
    4. Other tumors
      1. Hydatidiform Mole
  7. References
    1. Stenchever (2001) Comprehensive Gynecology, p. 1125-42
    2. Serri (2003) CMAJ 169:575

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