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Prolactin Deficiency Clinical Presentation

  • Author: Charles T Benson, MD, PhD; Chief Editor: George T Griffing, MD  more...
 
Updated: Jun 10, 2014
 

History

The most important historical finding in prolactin deficiency is puerperal alactogenesis. A history of anterior pituitary dysfunction is also important.

  • Menstrual disorders, delayed puberty, infertility, and subfertility are important historically, secondary to their association with hypoprolactinemia.
  • Inadequate lactation is speculated to be secondary to a partial prolactin deficiency and can be considered a historical marker.
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Physical

No specific physical findings are associated with hypoprolactinemia other than puerperal alactogenesis. The most common symptom complex of anterior pituitary dysfunction in men and women is secondary hypogonadism caused by deficiencies of luteinizing hormone (LH) and follicle-stimulating hormone (FSH).

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Causes

The most common causes of prolactin deficiency include postpartum pituitary necrosis (Sheehan syndrome)[15, 16] and all other causes of anterior pituitary dysfunction.[17]

  • Classically, the typical sequence in loss of pituitary hormones is the following:
    • Gonadotropins (LH, FSH)
    • Growth hormone
    • Thyrotropin-stimulating hormone
    • Corticotropin
    • Prolactin (deficiency uncommon except with pituitary infarction [Sheehan syndrome])
  • Another cause can be medication (ie, dopamine infusion, ergot preparation, pyridoxine, diuretics). Nicotine also diminishes the amount of prolactin released in response to the suckling stimulus. This may explain the decreased milk yield in mothers who smoke; they have been found to lactate for a shorter time than do comparable groups of mothers who do not smoke. Although plasma prolactin levels are usually within the reference range in anorexia, bulimic patients have been reported to have either reference-range or low prolactin levels.
  • Retained placental fragments in the peripartum interval can also suppress prolactin.
  • Prolactin deficiency is associated with G-protein mutations, such as Albright hereditary osteodystrophy. In this case, it may be found with olfactory dysfunction in type I pseudohypoparathyroidism.
  • Prolactin deficiency is found in a rare hereditary disorder called multiple pituitary hormone deficiency (MPHD). This familial occurrence has been associated with mutation of the PROP1 gene or Pit1 gene (also called POU1F1).[18, 19, 20] These genes encode transcription factors that are necessary for the differentiation of lactotrophs, as well as of somatotrophs and thyrotrophs. MPHD is associated not only with prolactin deficiency, but usually with somatotropin (growth hormone [GH], thyrotropin [also known as thyroid-stimulating hormone, or TSH]) deficiencies as well.
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Contributor Information and Disclosures
Author

Charles T Benson, MD, PhD Medical Fellow, Eli Lilly and Company, UK

Disclosure: Received salary from Eli Lilly & Co for employment.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Yoram Shenker, MD Chief of Endocrinology Section, Veterans Affairs Medical Center of Madison; Interim Chief, Associate Professor, Department of Internal Medicine, Section of Endocrinology, Diabetes and Metabolism, University of Wisconsin at Madison

Yoram Shenker, MD is a member of the following medical societies: American Heart Association, Central Society for Clinical and Translational Research, Endocrine Society

Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD Professor Emeritus of Medicine, St Louis University School of Medicine

George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, International Society for Clinical Densitometry, Southern Society for Clinical Investigation, American College of Medical Practice Executives, American Association for Physician Leadership, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical and Translational Research, Endocrine Society

Disclosure: Nothing to disclose.

Additional Contributors

Frederick H Ziel, MD Associate Professor of Medicine, University of California, Los Angeles, David Geffen School of Medicine; Physician-In-Charge, Endocrinology/Diabetes Center, Director of Medical Education, Kaiser Permanente Woodland Hills; Chair of Endocrinology, Co-Chair of Diabetes Complete Care Program, Southern California Permanente Medical Group

Frederick H Ziel, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Endocrinology, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Diabetes Association, American Federation for Medical Research, American Medical Association, American Society for Bone and Mineral Research, California Medical Association, Endocrine Society, International Society for Clinical Densitometry

Disclosure: Nothing to disclose.

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