Hypoprolactinemia Following Traumatic Brain Injury and Pituitary Surgery: Mechanisms, Prevalence, and Clinical Implications

Abstract Posttraumatic hypoprolactinemia is an often overlooked complication following traumatic brain injury (TBI) or pituitary surgery, characterized by abnormally low prolactin levels. Produced by the anterior pituitary gland, prolactin is essential for lactation, reproduction, and immune function. Damage to the hypothalamic-pituitary-axis can lead to hypoprolactinemia, causing symptoms such as lactation failure, reproductive dysfunction, mood disturbances, and immune impairment. The prevalence of hypoprolactinemia after TBI varies from 1 to 85%, while it is lower in postpituitary surgery. There is a lack of standardized diagnostic criteria and effective management strategies. This review covers the epidemiology, pathophysiology, clinical manifestations, and diagnostic challenges, while discussing therapeutic approaches like prolactin replacement therapy. Emphasizing the need for multidisciplinary care, the review also highlights the importance of research to establish diagnostic criteria and improve detection and treatment, as early intervention is crucial for better patient outcomes.