Low prolactin is uncommon and usually reflects dopamine agonist use (for example cabergoline or bromocriptine) or hypothalamic-pituitary dysfunction / broader anterior pituitary insufficiency.
Very low prolactin has also been associated in observational studies with insulin resistance, metabolic syndrome, and visceral adiposity.
Elevated prolactin is commonly caused by prolactinoma, medications (especially antipsychotics, metoclopramide, antidepressants, opioids, methyldopa, and some calcium-channel blockers), hypothyroidism, and pregnancy/lactation.
Prolactin can also rise transiently with stress, sleep, exercise, sex, nipple stimulation, and chest wall stimulation or injury. Other causes include pituitary stalk lesions, chronic kidney disease, and liver disease.
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