Any drugs which reduce dopamine will reduce inhibition of prolactin so increase prolactin levels
Dopamine antagonists e.g. metoclopramide
Antipsychotics e.g. phenothiazines
Less commonly: antidepressants e.g. TCA, SSRIs, oestrogens, cocaine
Pathological
Hypothyroidism
Stalk compression due to pituitary adenomas and other pituitary masses
Damage to stalk - iatrogenic, road accident
Prolactinoma
Clinical presentation
Patients may present with features of hyperprolactinaemia or structual symptoms from a pituitary tumour with headaches and visual loss (latter presentation more common in males)
Females - early presentation
Galactorrhoea (30-80%)
Menstrual irregulatity (25%)
Decreased lipido
Ammenorrhoea
Infertility
Males - late presentation
Impotence
Visual field abnormal
Headaches
Anterior pituitary malfunction
Investigations
Serum prolactin raised
Once physiological and drug causes have been excluded:
Visual fields - bitemporal temianopia
Exclude primary hypothyroidism
Assess anterior pituitary function
MRI pituitary if there are any clinical features of a pituitary tumour, and in all cases where prolactin is significantly raised
Management - Prolactinoma
Dopamine agonists
Usually cabergoline (Dostinex)
Normalises prolactin and shrinks tumour in the vast majority - very rarely consider surgery because of this
If tumour does not shrink consider transsphenoidal surgery or radiotherapy
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