PHYSICAL EXAMINATION

LABORATORY STUDIES

DIAGNOSIS

Hyperprolactinemia

PATHOPHYSIOLOGY OF KEY SYMPTOMS

The patient’s major symptoms are centered around reproduction. Erectile dysfunction can have many causes: vascular, neural, endocrine, and psychologic. The decrease in libido, accompanied by hypogonadism, suggests a drop in testosterone levels. Galactorrhea is an unusual finding in males and indicates an elevated prolactin level. Headaches and visual disturbances are consistent with a problem in the pituitary, the site of prolactin production.

Prolactin is an important hormone of pregnancy, stimulating the growth of the breast epithelial cells and the production of milk. Prolactin levels increase during the last trimester of pregnancy, in preparation for nursing (Fig. 75-1). After delivery, prolactin levels fall to baseline over the next 8 to 12 weeks. There is a surge in prolactin production for about 1 hour during and after nursing that persists as long as the mother continues to nurse. The prolactin surges allow milk production to continue until the infant is weaned.

FIGURE 75–1 Changes in rates of secretion of estrogens, progesterone, and prolactin for 8 weeks before parturition and 36 weeks thereafter. Note especially the decrease of prolactin secretion back to basal levels within a few weeks after parturition but also the intermittent periods of marked prolactin secretion (for about 1 hour at a time) during and after periods of nursing.