Which symptom is most indicative of hyperprolactinemia due to antipsychotics?

• A. Visual disturbance only
• B. Galactorrhea, amenorrhea, infertility, gynecomastia
• C. Cough and fever
• D. Hypertension

Answer: (B)

Dopamine normally keeps prolactin in check, especially in the tuberoinfundibular pathway. When antipsychotics block D2 receptors there, prolactin levels rise. That rise produces reproductive system effects that are highly characteristic: galactorrhea (milky breast discharge), amenorrhea (absence of periods), infertility, and gynecomastia in men. This combination is the clearest signal that antipsychotic-induced hyperprolactinemia is at play, because it directly reflects elevated prolactin's impact on lactation and gonadal function.

Other signs like visual disturbances can occur with pituitary tumors, but they are not the typical or most specific indicators of drug-induced prolactin elevation. Cough with fever or high blood pressure don’t relate to prolactin changes and aren’t how this condition presents.