Hypoprolactinemia Explained

Hypoprolactinemia
Field:	Gynecology

Hypoprolactinemia is a medical condition characterized by a deficiency in the serum levels of the hypothalamic-pituitary hormone prolactin.^{[1] [2]}

Signs and symptoms

Hypoprolactinemia is associated with ovarian dysfunction in women, and, in men, metabolic syndrome,^[3] anxiety symptoms, arteriogenic erectile dysfunction,^[4] premature ejaculation, oligozoospermia (low concentration of sperm in semen), asthenospermia (reduced sperm motility), hypofunction of seminal vesicles, and hypoandrogenism. In one study, normal sperm characteristics were restored when prolactin levels were brought up to normal values in men with hypoprolactinemia. Hypoprolactinemia can be a cause of lactation failure after childbirth.^{[5] [6]}

Causes

Hypoprolactinemia can result from autoimmune disease, hypopituitarism, growth hormone deficiency, hypothyroidism, excessive dopamine action in the tuberoinfundibular pathway and/or the anterior pituitary, and ingestion of drugs that activate the D₂ receptor, such as direct D₂ receptor agonists like bromocriptine and pergolide, and indirect D₂ receptor activators like amphetamines (through the induction of dopamine release).^[7]

Diagnosis

Guidelines for diagnosing hypoprolactinemia are defined as prolactin levels below 3 μg/L in women,^{[8] [9]} and 5 μg/L in men.^{[10] [11] [12]}

Management

There are few treatments which increase prolactin levels in humans. Treatment differs based on the reason for diagnosis. Women who are diagnosed with hypoprolactinemia following lactation failure are typically advised to formula feed, although treatment with metoclopramide has been shown to increase milk supply in clinical studies. For subfertility, treatment may include clomiphene citrate or gonadotropins.^[13]

See also

• Hypothalamic–pituitary–prolactin axis
• Hyperprolactinemia

Notes and References

1. Book: Jerome F. Strauss III. Robert L. Barbieri. Yen & Jaffe's Reproductive Endocrinology: Physiology, Pathophysiology, and Clinical Management. 28 August 2013. Elsevier Health Sciences. 978-1-4557-5972-9. 53–.
2. Book: Andrew S. Davis. Handbook of Pediatric Neuropsychology. 25 October 2010. Springer Publishing Company. 978-0-8261-5737-9. 1134–.
3. Emmanuele A. Jannini. Corona. Giovanni. Mannucci. Edoardo. Jannini. Emmanuele A. Lotti. Francesco. Ricca. Valdo. Monami. Matteo. Boddi. Valentina. Bandini. Elisa. Balercia. Giancarlo. Forti. Gianni. Maggi. Mario. Hypoprolactinemia: A New Clinical Syndrome in Patients with Sexual Dysfunction. Journal of Sexual Medicine. 6. 5. 2009. 1457–1466. 1743-6095. 10.1111/j.1743-6109.2008.01206.x. 19210705.
4. Book: Pituitary Hormones—Advances in Research and Application: 2013 Edition. 21 June 2013. ScholarlyEditions. 978-1-4816-7922-0. 62–.
5. Prabhakar VK, Shalet SM . Aetiology, diagnosis, and management of hypopituitarism in adult life . Postgrad Med J . 82 . 966 . 259–66 . 2006 . 16597813 . 2585697 . 10.1136/pgmj.2005.039768 .
6. Book: Robert F. Dons. Frank H. Wians, Jr.. Endocrine and Metabolic Disorders: Clinical Lab Testing Manual, Fourth Edition. 17 June 2009. CRC Press. 978-1-4200-7936-4. 103–.
7. Book: Trevor W. Stone. CNS Neurotransmitters and Neuromodulators. 9 May 1996. CRC Press. 978-0-8493-7632-0. 214–.
8. Kauppila A, Martikainen H, Puistola U, Reinilä M, Rönnberg L . Hypoprolactinemia and ovarian function . Fertil. Steril. . Mar 1988 . 49 . 3 . 437–41 . 3342895 . 10.1016/s0015-0282(16)59769-6.
9. Schwärzler P, Untergasser G, Hermann M, Dirnhofer S, Abendstein B, Berger P . Prolactin gene expression and prolactin protein in premenopausal and postmenopausal human ovaries . Fertil. Steril. . Oct 1997 . 68 . 4 . 696–701 . 9341613 . 10.1016/S0015-0282(97)00320-8 . free .
10. Corona G, Mannucci E, Jannini EA, Lotti F, Ricca V, Monami M, Boddi V, Bandini E, Balercia G, Forti G, Maggi M . Hypoprolactinemia: a new clinical syndrome in patients with sexual dysfunction . J. Sex. Med. . 6 . 5 . 1457–66 . May 2009 . 19210705 . 10.1111/j.1743-6109.2008.01206.x .
11. Gonzales GF, Velasquez G, Garcia-Hjarles M . Hypoprolactinemia as related to seminal quality and serum testosterone . Arch. Androl. . 23 . 3 . 259–65 . 1989 . 2619414 . 10.3109/01485018908986849 .
12. Ufearo CS, Orisakwe OE . Restoration of normal sperm characteristics in hypoprolactinemic infertile men treated with metoclopramide and exogenous human prolactin . Clin Pharmacol Ther . 58 . 3 . 354–9 . September 1995 . 7554710 . 10.1016/0009-9236(95)90253-8 .
13. Web site: Prolactin Deficiency Medication: Antidopaminergic agents. emedicine.medscape.com. en. 2017-11-25.