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Hyperprolactinemia is a state of persistent excessive content of prolactin in the blood serum. The condition is a cause of reproductive problems and infertility, which is why the treatment of hyperprolactinemia requires a thorough approach.
Epidemiology
Hyperprolactinemia is the most common disease of the hypothalamic-pituitary system. Aside from pituitary tumors, an elevated prolactin level can be a consequence of other pathological processes. This condition is found in 15-20% of women with secondary amenorrhea or oligomenorrhea, in 17% of women with Polycystic Ovary Syndrome (PCOS), and in 10% of men with sexual dysfunction. The prevalence of pathological hyperprolactinemia ranges from 10 to 30 cases per 100 thousand people.
Causes of the Condition
The causes of the condition can be divided into physiological, pharmaceutical, and pathological.
Physiological
The concentration of prolactin can increase during physiological processes familiar to every person: physical exercise, deep sleep phase, sexual intercourse, pregnancy, lactation, stress. In humans, prolactin secretion has a pulsatile and non-constant nature. All these processes can have a direct or indirect influence on the hypothalamic-pituitary system, as well as on the level of estrogens (which, essentially, are responsible for the excessive production of prolactin).
Pathological
One of the most common causes is a dysfunction of the hypothalamus and/or the pituitary gland. The hypothalamus is a part of the brain that controls the function of the endocrine system. It is responsible for the regulation and control of many important bodily functions, including the regulation of appetite, sleep, synthesis of growth hormone, and the function of the adrenal cortex and thyroid gland.
The hypothalamus and prolactin are closely interconnected in the process of regulating mammary gland function in women. The hypothalamus produces Gonadotropin-Releasing Hormone (GnRH), which stimulates the anterior pituitary gland to secrete the hormone lactotropin or prolactin. Prolactin, in turn, regulates the growth and development of the mammary glands and stimulates milk production. Furthermore, the hypothalamus directly influences the prolactin level through negative feedback with the anterior pituitary. If the prolactin level in the blood is elevated, the hypothalamus signals the pituitary to reduce prolactin secretion. The hypothalamus also controls prolactin secretion through other hormones, including growth hormone and thyrotropin. Accordingly, a hypothalamic/pituitary dysfunction leads to an increase in prolactin levels and the onset of hyperprolactinemia.
Other pathological conditions that can cause the development of this condition include: hypothyroidism and other endocrine diseases, liver cirrhosis, chronic renal failure, PCOS, epileptic seizure, herpes zoster (shingles), Rathke's cleft cyst, various types of tumors, radiation, brain trauma, surgical interventions (for example, damage to the pituitary stalk), and pseudopregnancy syndrome (false pregnancy).
Pharmaceutical
Hyperprolactinemia can even be caused by medications, including: antihistamines, anesthetics, antidepressants, neuropeptides, neuroleptics (antipsychotics), estrogens, anticonvulsants, dopamine receptor blockers, opiates, and antitumor drugs.
Symptoms
In women, the symptomatology may include: galactorrhea, menstrual cycle disorders (amenorrhea, anovulation), decreased libido, frigidity, anorgasmia, hirsutism, seborrhea, acne, and hyperplasia of the labia/clitoris.
Hyperprolactinemia in men manifests through: gynecomastia (female-type breast growth), decreased libido, erectile dysfunction up to impotence, ophthalmoplegia (paralysis of eye muscles), sleep disturbances, onset of excessive irritability, general weakness, increased fatigue, and memory impairment.
Complications of Hyperprolactinemia
Hyperprolactinemia can cause various complications. Among them are:
• Menstrual cycle disturbance: It may become irregular or menstruation stops completely.
• Infertility: An increased prolactin level can lead to a reduced probability of pregnancy or its termination.
• Galactorrhea: This is a condition where women secrete milk from the breast outside the breastfeeding period. Milk secretion from the breast may also be observed in men.
• Reduced bone mineral density: Hyperprolactinemia can lead to osteoporosis, which increases the risk of bone fractures.
• Irritability and depression: The prolactin level influences serotonin function, which can lead to increased sensitivity to stress, depression, and other mental disorders.
• Thyroid dysfunction: An elevated prolactin level can reduce the production of thyroid hormones - thyroxine (T4) and triiodothyronine (T3), leading to hypothyroidism.
• Migraine: Hyperprolactinemia directly affects hypothalamic receptors, which influences the secretion of neuropeptides. This entails a lowering of the pain reaction threshold and contributes to the onset of migraine.
Diagnosis
The diagnosis of the condition is handled by endocrinologists and gynecologists. Diagnosing hyperprolactinemia can be a challenging task. It requires:
• Laboratory diagnostics: This involves not only determining the prolactin level but also its isoforms with high biological activity. Blood should be drawn no later than the 7th day of the menstrual cycle. It is recommended to perform the laboratory test of the prolactin level at least twice, to take tests for hormones (LH, FSH, T3, T4, TSH, ACTH, Anti-Müllerian Hormone), a careful study of the anamnesis (medical history), exclusion of various somatic, endocrine, neuroendocrine disorders, and exclusion of a pharmaceutical nature of the condition. At the appointment, the doctor thoroughly questions the patient about the intake of medications or dietary supplements.
• General physical examination: This involves assessing the general physical condition, height and body mass, secondary sexual characteristics, and traces of intravenous injections. In patients with hyperprolactinemia, an assessment of the neurological status, examination of the thyroid gland function, and a careful inspection of the mammary (breast) glands are also necessary.
• Breast examination for the purpose of detecting galactorrhea consists of expressing milk with movements from the edges of the areola towards the center of the nipple. If milk appears, it is a sign of galactorrhea.
• MRI may be prescribed to the patient as the most informative method in the diagnosis of tumors of the hypothalamic-pituitary region.
Treatment Methods
Treatment is carried out on an outpatient basis, except for cases of unclear nature of the condition, unresolving symptoms, or preparation for surgery. It requires a differentiated and individualized approach considering clinical, laboratory, and instrumental data.
Conservative treatment includes:
• Normalization of the prolactin level.
• Treatment of the underlying cause of the condition.
• Elimination of hyperprolactinemia symptoms.
• Restoration of fertility.
The patient may be prescribed: dopamine receptor agonists, glucocorticosteroids, antibiotics, drugs that normalize the prolactin level, and a vitamin-mineral complex.
Each clinical case is individual. Therefore, it is primarily necessary to consult a gynecologist. After conducting a comprehensive examination, the specialist will prescribe suitable treatment methods and approaches.
Hyperprolactinemia is the most common disease of the hypothalamic-pituitary system. Aside from pituitary tumors, an elevated prolactin level can be a consequence of other pathological processes. This condition is found in 15-20% of women with secondary amenorrhea or oligomenorrhea, in 17% of women with Polycystic Ovary Syndrome (PCOS), and in 10% of men with sexual dysfunction. The prevalence of pathological hyperprolactinemia ranges from 10 to 30 cases per 100 thousand people.
Causes of the Condition
The causes of the condition can be divided into physiological, pharmaceutical, and pathological.
Physiological
The concentration of prolactin can increase during physiological processes familiar to every person: physical exercise, deep sleep phase, sexual intercourse, pregnancy, lactation, stress. In humans, prolactin secretion has a pulsatile and non-constant nature. All these processes can have a direct or indirect influence on the hypothalamic-pituitary system, as well as on the level of estrogens (which, essentially, are responsible for the excessive production of prolactin).
Pathological
One of the most common causes is a dysfunction of the hypothalamus and/or the pituitary gland. The hypothalamus is a part of the brain that controls the function of the endocrine system. It is responsible for the regulation and control of many important bodily functions, including the regulation of appetite, sleep, synthesis of growth hormone, and the function of the adrenal cortex and thyroid gland.
The hypothalamus and prolactin are closely interconnected in the process of regulating mammary gland function in women. The hypothalamus produces Gonadotropin-Releasing Hormone (GnRH), which stimulates the anterior pituitary gland to secrete the hormone lactotropin or prolactin. Prolactin, in turn, regulates the growth and development of the mammary glands and stimulates milk production. Furthermore, the hypothalamus directly influences the prolactin level through negative feedback with the anterior pituitary. If the prolactin level in the blood is elevated, the hypothalamus signals the pituitary to reduce prolactin secretion. The hypothalamus also controls prolactin secretion through other hormones, including growth hormone and thyrotropin. Accordingly, a hypothalamic/pituitary dysfunction leads to an increase in prolactin levels and the onset of hyperprolactinemia.
Other pathological conditions that can cause the development of this condition include: hypothyroidism and other endocrine diseases, liver cirrhosis, chronic renal failure, PCOS, epileptic seizure, herpes zoster (shingles), Rathke's cleft cyst, various types of tumors, radiation, brain trauma, surgical interventions (for example, damage to the pituitary stalk), and pseudopregnancy syndrome (false pregnancy).
Pharmaceutical
Hyperprolactinemia can even be caused by medications, including: antihistamines, anesthetics, antidepressants, neuropeptides, neuroleptics (antipsychotics), estrogens, anticonvulsants, dopamine receptor blockers, opiates, and antitumor drugs.
Symptoms
In women, the symptomatology may include: galactorrhea, menstrual cycle disorders (amenorrhea, anovulation), decreased libido, frigidity, anorgasmia, hirsutism, seborrhea, acne, and hyperplasia of the labia/clitoris.
Hyperprolactinemia in men manifests through: gynecomastia (female-type breast growth), decreased libido, erectile dysfunction up to impotence, ophthalmoplegia (paralysis of eye muscles), sleep disturbances, onset of excessive irritability, general weakness, increased fatigue, and memory impairment.
Complications of Hyperprolactinemia
Hyperprolactinemia can cause various complications. Among them are:
• Menstrual cycle disturbance: It may become irregular or menstruation stops completely.
• Infertility: An increased prolactin level can lead to a reduced probability of pregnancy or its termination.
• Galactorrhea: This is a condition where women secrete milk from the breast outside the breastfeeding period. Milk secretion from the breast may also be observed in men.
• Reduced bone mineral density: Hyperprolactinemia can lead to osteoporosis, which increases the risk of bone fractures.
• Irritability and depression: The prolactin level influences serotonin function, which can lead to increased sensitivity to stress, depression, and other mental disorders.
• Thyroid dysfunction: An elevated prolactin level can reduce the production of thyroid hormones - thyroxine (T4) and triiodothyronine (T3), leading to hypothyroidism.
• Migraine: Hyperprolactinemia directly affects hypothalamic receptors, which influences the secretion of neuropeptides. This entails a lowering of the pain reaction threshold and contributes to the onset of migraine.
Diagnosis
The diagnosis of the condition is handled by endocrinologists and gynecologists. Diagnosing hyperprolactinemia can be a challenging task. It requires:
• Laboratory diagnostics: This involves not only determining the prolactin level but also its isoforms with high biological activity. Blood should be drawn no later than the 7th day of the menstrual cycle. It is recommended to perform the laboratory test of the prolactin level at least twice, to take tests for hormones (LH, FSH, T3, T4, TSH, ACTH, Anti-Müllerian Hormone), a careful study of the anamnesis (medical history), exclusion of various somatic, endocrine, neuroendocrine disorders, and exclusion of a pharmaceutical nature of the condition. At the appointment, the doctor thoroughly questions the patient about the intake of medications or dietary supplements.
• General physical examination: This involves assessing the general physical condition, height and body mass, secondary sexual characteristics, and traces of intravenous injections. In patients with hyperprolactinemia, an assessment of the neurological status, examination of the thyroid gland function, and a careful inspection of the mammary (breast) glands are also necessary.
• Breast examination for the purpose of detecting galactorrhea consists of expressing milk with movements from the edges of the areola towards the center of the nipple. If milk appears, it is a sign of galactorrhea.
• MRI may be prescribed to the patient as the most informative method in the diagnosis of tumors of the hypothalamic-pituitary region.
Treatment Methods
Treatment is carried out on an outpatient basis, except for cases of unclear nature of the condition, unresolving symptoms, or preparation for surgery. It requires a differentiated and individualized approach considering clinical, laboratory, and instrumental data.
Conservative treatment includes:
• Normalization of the prolactin level.
• Treatment of the underlying cause of the condition.
• Elimination of hyperprolactinemia symptoms.
• Restoration of fertility.
The patient may be prescribed: dopamine receptor agonists, glucocorticosteroids, antibiotics, drugs that normalize the prolactin level, and a vitamin-mineral complex.
Each clinical case is individual. Therefore, it is primarily necessary to consult a gynecologist. After conducting a comprehensive examination, the specialist will prescribe suitable treatment methods and approaches.
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