FRI315 Hyperprolactinemia In The Presence Of Severe Calorie Restriction And Stress
Authors: Alrasheed Tariq , Alanazi Mansuor , Albishi Laila , Mirghani Hyder 
Published: October 2023

Disclosure: T. Alrasheed: None. M. Alanazi: None. L. Albishi: None. H. Mirghani: None.

Abstract: The effects of obesity and calorie restriction on prolactin levels (PL) are controversial. Here, we have an unusual case of physiological hyperprolactinemia in the presence of severe calorie restriction and emotional stressors. Case Presentation A 31-year-old security guard with obesity (31.5 kg/m2) started dieting by adopting severe calorie restrictions at 900 calories a day. He lost about 15 kg in two months, but even with weight loss, he was in poor health. He felt fatigued and unable to work. On testing, he had an elevated PL of 78.93 ng/ml. The remaining tests were normal, however, with the elevated PL, he was referred to our endocrinology clinic. He had a negative medical, surgical, and family history. He had a normal physical exam. We increased his calorie intake gradually to ∼2000 calories/day. With these changes, his energy improved, and his symptoms were resolved. The repeated PL was normalized (14.70 ng/ml). Discussion In clinical practice, hyperprolactinemia can result from physiological, pharmacological, or pathological causes due to the widespread effect of prolactin on the body. One of the physiological causes is stress, which could raise PL to 100 ng/ml, although the exact mechanism needs further study. It has been suggested that physiological stress affects the neuroendocrine by inducing changes in dopamine and serotonin levels, contributing to the increase in PL. However, the relationship between PL and obesity is controversial. While there was no direct association between the two even after significant weight loss, (similarly, changes in calories did not show a direct effect on PL) there was a study that showed enhancement of prolactin release in obese women in proportion to the size of their visceral fat, and severe weight loss was associated with a reduction in PL. In our case, calorie restriction was the start of this cascade of symptoms and elevated PL. Decreased calorie intake affected his daily function, which led to his emotional stress, which in turn led to hyperprolactinemia. After increasing calorie consumption and resolving his physical stressors, his symptoms improved, and his PL was normalized. Conclusion A combination of low-calorie diets and stress could cause hyperprolactinemia. Further study is required to understand the clinical significance of elevated PL and its physiological functions. Knowing the widespread effect and relationship of prolactin in the body will help to avoid misdiagnoses and unnecessary treatments.

References 1. Ernst B, Thurnheer M, Schultes B. Basal serum prolactin levels in obesity—unrelated to parameters of the metabolic syndrome and unchanged after massive weight loss. Obes Surg. 2009 Aug;19(8):1159-62. doi: 10.1007/s11695-009-9856-0. 2.1Levine S., Muneyyirci-Delale O. Stress-Induced Hyperprolactinemia: Pathophysiology and Clinical Approach. Obs. Gynecol. Int. 2018;2018:9253083. DOI: 10.1155/2018/9253083.

Presentation: Friday, June 16, 2023