Galactorrhea

Definition

Prolactin is a hormone secreted by the anterior portion of the pituitary gland (sometimes called the "master gland"). Its role in the male has not been demonstrated, but in females, prolactin promotes lactation, or milk production, after childbirth.

Purpose

The prolactin test is used to diagnose pituitary dysfunction that might be caused by a tumor called an adenoma. In some circumstances, the test is also used to evaluate absence of menstrual periods (amenorrhea), or spontaneous production of milk (galactorrhea) by a woman who is not pregnant or lactating.

Precautions

Stress from trauma, illness, surgery, or even nervousness about a blood test can elevate prolactin levels. Drugs that may increase prolactin include phenothiazines, oral contraceptives, opiates, histamine antagonists, monoamine oxidase inhibitors (MAO inhibitors), estrogen, and antihistamines. Drugs that can decrease values include levodopa and dopamine.

Description

Prolactin is also known as the lactogenic hormone or lactogen. It is essential for the development of the mammary glands for lactation during pregnancy, and for stimulating and maintaining lactation after childbirth. Like the human growth hormone, prolactin acts directly on tissues, and its levels rise in response to sleep and to physical or emotional stress. During sleep, prolactin levels can increase to the circulating levels found in pregnant women (as high as ten to twenty times the normal level).

Prolactin secretion is controlled by prolactin-releasing and prolactin- inhibiting chemicals (factors) secreted by an area of the brain called the hypothalamus. Another hormone, thyroid-releasing hormone, or TRH, can also stimulate prolactin.

Tumors of the pituitary, called adenomas, are the most common cause of excessive levels of prolactin. Depending on the type of cell involved, these tumors are also called prolactin-secreting pituitary acidophilic or chromophobic adenomas. Moderately high prolactin levels are found to a lesser extent in women with secondary amenorrhea, galactorrhea, low thyroid, anorexia, and a disorder known as polycystic ovary syndrome, a disease whose cause is not well-known.

Because high prolactin levels are more likely due to pituitary adenoma than other causes, the prolactin level is used to diagnose and monitor this type of tumor. Several stimulation and suppression tests, with TRH or levodopa, respectively, have been designed to differentiate pituitary adenoma from other causes of prolactin overproduction.

Preparation

This test requires a blood sample that should be drawn in the morning at least two hours after the patient wakes (samples drawn earlier may show sleep- induced peak levels). The patient need not restrict food or fluids nor limit physical activity, but should relax for approximately 30 minutes before the test.

Risks

Risks posed by this test are minimal, but may include slight bleeding from the blood-drawing site, fainting or lightheadedness after venipuncture, or hematoma (blood accumulating under the puncture site).

Normal results

Reference ranges vary from laboratory to laboratory but are generally within the following values:

• Adult male: 0-20 ng/ml.
• Adult female: 0-20 ng/ml.
• Pregnant female: 20-400 ng/ml.

Abnormal results

Increased prolactin levels are found in galactorrhea, amenorrhea, prolactin-secreting pituitary tumor, infiltrative diseases of the hypothalamus, and metastatic cancer of the pituitary gland. Higher levels than normal are seen in stress which may be produced by anorexia nervosa, surgery, strenuous exercise, trauma, and in renal (kidney) failure.

Decreased prolactin levels are seen in Sheehan's syndrome, a condition of severe hemorrhage after obstetric delivery that causes decreased blood supply to the pituitary.

Key Terms

Adenoma

A benign tumor

Amenorrhea

The absence or abnormal stoppage of menstrual periods.

Factor

Any of several substances necessary to produce a result or activity in the body. The term is used when the chemical nature of the substance is unknown. In endocrinology, when the chemical nature is known, factors are renamed hormones.

Galactorrhea

Excessive or spontaneous flow of milk.

Pituitary gland

A gland located at the base of the brain, and controlled by the hypothalamus. It controls most endocrine functions and is responsible for things such as kidney function, lactation, and growth and development.

Further Reading

For Your Information

Books

• Cahill, Mathew Handbook of Diagnostic Tests. Springhouse, PA: Springhouse Corporation, 1995.
• Jacobs, David S. Laboratory Test Handbook. 4th ed. Hudson, Ohio: Lexi-Comp Inc., 1996.
• Pagana, Kathleen Deska Mosby's Manual of Diagnostic and Laboratory Tests. St. Louis, MO: Mosby, Inc., 1998.

Gale Encyclopedia of Medicine. Gale Research, 1999.