HyperprolactinaemiaHyperprolactinaemia is the term given to having too high levels of prolactin in the blood. (Normal levels are less than 580 mIU/L for women, and less than 450 mIU/L for men.)
Prolactin is a hormone secreted by lactotropes in the adenohypophysis (anterior pituitary gland), which is made up of 199 amino acids with a molecular weight of about 23,000 daltons. Prolactin has many effects, the most profound of which are to stimulate the mammary glands to produce milk (i.e. lactation). Increased serum prolactin during pregnancy causes enlargement of the mammary glands of the breasts and increases the production of milk. Sometimes, newborn babies (males as well as females) secrete a milky substance from their nipples in a phenomenon called Witches' milk. This is caused by the fetus being affected by prolactin circulating in the mother just before birth. This usually resolves soon after birth.
There is a diurnal as well as a ovulatory cycle variation in prolactin levels. During pregnancy, prolactin levels rise as rising estrogen promotes prolactin release, causing further maturing of mammary glands, preparing them for lactation. After childbirth, prolactin levels fall as the internal stimulus for them is removed. Sucking by the baby on the nipple promotes further prolactin release, maintaining the ability to lactate. Usually, in the absence of galactorrhea, lactation will cease within one or two weeks of the end of demand breastfeeding. High prolactin levels also tend to suppress the ovulatory cycle by inhibiting both FSH and GnRH.
As a contraceptive, demand breastfeeding is said to be more than 90% effective in the first month of post-partum even if no other forms of contraception are used, with decreasing effectiveness in successive months. Those are pretty good figures, though it is advised that this should not be relied on as the only contraceptive for any long period of time.
Hyperprolactinaemia is a common cause of menstrual problems in women, and high levels of prolactin can cause gynecomastia (breast enlargement) in men. It can also cause galactorrhea One cause of hyperprolactinaemia is the presence of the biologically inactive macroprolactin in the serum. This can show up as high prolactin in some types of tests, but is asymptomatic. Another cause of hyperprolactinaemia is a prolactinoma, a pituitary gland tumour. The hormone prolactin is downregulated by dopamine and is upregulated by estrogen.