Hyperprolactinemia is an endocrine disorder characterized by abnormally elevated levels of prolactin, a hormone produced by the anterior pituitary gland. Prolactin plays a primary role in breast development and lactation, but excessive levels disrupt normal reproductive, metabolic, and hormonal balance in both women and men.

The most common cause of hyperprolactinemia is a prolactin-secreting pituitary adenoma, also known as a prolactinoma. Other causes include medications that interfere with dopamine signaling, hypothyroidism, chronic kidney disease, chest wall stimulation, pregnancy, and stress. Because dopamine normally inhibits prolactin secretion, any disruption in this regulatory pathway can lead to elevated hormone levels.

Clinical presentation varies by sex and age. In women, hyperprolactinemia commonly causes menstrual irregularities, infertility, galactorrhea, and reduced estrogen levels, which may lead to bone loss over time. In men, symptoms include reduced libido, erectile dysfunction, infertility, gynecomastia, and decreased testosterone levels. Headaches and visual disturbances may occur when pituitary tumors enlarge and compress nearby structures.

Diagnosis begins with measurement of serum prolactin levels, confirmed on repeat testing to exclude transient elevations due to stress or physiological causes. Once confirmed, further evaluation includes thyroid function testing, kidney assessment, and pituitary imaging when indicated. Magnetic resonance imaging is the preferred modality to identify pituitary adenomas and assess tumor size.

Management depends on the underlying cause and symptom severity. Prolactinomas are most commonly treated with dopamine agonists, which effectively reduce prolactin levels, restore reproductive function, and shrink tumor size in the majority of patients. Surgical intervention is reserved for selected cases where medical therapy is ineffective or not tolerated.

Long-term follow-up includes monitoring hormone levels, symptoms, bone health, and imaging when required. Early diagnosis and appropriate treatment restore hormonal balance, improve fertility outcomes, and prevent long-term complications such as osteoporosis. With structured endocrine care, hyperprolactinemia is a highly treatable condition with excellent prognosis.