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.

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).

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.

Differential Diagnoses

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