{"id":26009,"date":"2025-12-18T17:00:04","date_gmt":"2025-12-18T17:00:04","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=26009"},"modified":"2025-12-19T09:48:21","modified_gmt":"2025-12-19T09:48:21","slug":"prolactin","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/prolactin\/","title":{"rendered":"Prolactin"},"content":{"rendered":"\n

Prolactin Measurement in Adults<\/u><\/strong><\/p>\n\n\n\n

Prolactin is produced by lactotrophs in the pituitary gland.  Its biological function is to induce and maintain lactation in breast tissue for breast feeding.<\/p>\n\n\n\n

Prolactin can be easily measured in serum and references ranges for men and women are calculated from the healthy population.  In modern assays \u2018macroprolactin\u2019 (autoimmunity to prolactin causing a spurious hyperprolactinaemia) is routinely analysed in repeatedly elevated samples and reported.  In these cases, the \u2018monomeric\u2019<\/strong> result should be used.<\/p>\n\n\n\n

Physiologically, lactotrophs are \u2018kept in check\u2019 by dopaminergic neurones from the hypothalamus which suppress prolactin production out-with periods of breast-feeding requirement.   Therefore, any interruption of this process will increase prolactin levels.<\/p>\n\n\n\n

Common causes of elevated prolactin are as follows<\/u><\/strong>:<\/p>\n\n\n\n

1. Physiological<\/span><\/strong><\/p>\n\n\n\n

– Coitus
– Exercise
– Lactation
– Stimulation of nipples (including checking for galactorrhoea)
– Pregnancy
– Stress- emotional and physiological<\/p>\n\n\n\n

2.Drug induced \u2013 common \u2013 non exhaustive list (common drug culprits<\/em>)<\/span><\/strong><\/p>\n\n\n\n

– Oral contraceptives (not including progesterone only preparations)<\/span>
– Antipsychotics <\/span>(phenothiazines, risperidone, haloperidol, olanzapine, amisulpiride, clozapine, quetiapine)<\/em>
– Antiemetics (<\/span>metoclopramide, domperidone, prochlorperazine<\/em>)<\/span>
– Antidepressants (<\/span>tricyclic antidepressants, SSRIs, monoaminoxidase inhibitors, SNRIs e.g. venlafaxine<\/em>)<\/span>
– Antihypertensives (verapamil)<\/span>
– Antihistamines (H2 receptor blockers)<\/span>
– Opiates<\/p>\n\n\n\n

3.Pituitary pathology<\/span><\/strong><\/p>\n\n\n\n

– Pituitary prolactinoma or mixed secreting pituitary tumour<\/span>
– Hypothalamic-pituitary stalk damage (other pituitary or external mass, trauma, surgery)<\/p>\n\n\n\n

4.Systemic disorders<\/span><\/strong>

–Chronic kidney disease<\/span>
– Hepatic cirrhosis<\/span>
– Seizures<\/span>
– PCOS<\/span>
– Chest wall irritation \u2013 trauma, shingles, surgery<\/p>\n\n\n\n

INDICATIONS FOR MEASURING PROLACTIN<\/u><\/strong><\/p>\n\n\n\n

Measuring prolactin levels without indication incurs significant cost due to unnecessary investigation as well as unnecessarily increasing patient concern<\/em><\/strong>.  Examples in which prolactin is often measured without clear indication are headache, heavy menstrual bleeding and irregular periods (without oligomenorrhoea).<\/p>\n\n\n\n

Clinical indications for measurement of prolactin in adults are<\/u><\/strong>:<\/p>\n\n\n\n