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Recent studies revealed that elevated prolactin induces pancreatic beta cells to secrete insulin

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[6] Early cases were reported with liver dysfunction, muscular findings (weakness and underdevelopment), hypoketotic hypoglycemia, cardiomegaly, cardiomyopathy and marked carnitine deficiency in plasma and tissues, combined with increased excretion in urine

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The end result is gastric atrophy and depletion of intrinsic factor leading to poor absorption of food-bound, free, and biliary vitamin B 12 .2 Malabsorption is more complete and severe in PA compared to food-cobalamin malabsorption which is more partial in nature,2 and so the manifestations are more overt and severe in PA