| Clinical disorders of prolactin secretion
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| There are no known prolactin deficiency syndromes but hyperprolactinemia is very common
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| Hyperprolactinemia may result from a prolactin-secreting pituitary tumor (prolactinoma), a deficient supply of dopamine from the hypothalamus, or the use of any of a wide range of antidopaminergic drugs. In women, the presenting features of hyperprolactinemia include menstrual irregularity and galactorrhea (discharge of milk from the breast). A grossly elevated serum prolactin is usually diagnostic of a prolactinoma. For subjects with modest hyperprolactinemia, who are not taking antidopaminergic drugs, the differential diagnosis is difficult; pituitary imaging and/or dynamic tests of prolactin secretion will assist the diagnosis of a microprolactinoma. Treatment options include long-acting dopamine agonist drugs or surgery. In men, hyperprolactinemia can cause impotence and prostatic hyperplasia. However, because other conditions more commonly produce these symptoms, the diagnosis of hyperprolactinemia is often missed until prolactinomas become very large and present as hypopituitarism with visual field defects. The latter symptoms arise when the tumor expands out of the pituitary fossa and impinges on the optic chiasm. Such tumors often shrink with dopamine agonist therapy.
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