Hyperprolactinemia
The content of the article:
- Causes of hyperprolactinemia
- Forms of hyperprolactinemia
- Symptoms of hyperprolactinemia
- Diagnostics
- Treatment of hyperprolactinemia
- Hyperprolactinemia in children
- Prevention
- Consequences and complications
Hyperprolactinemia is an increase in the concentration of prolactin in the blood, which can be both physiological and pathological in nature.
Prolactin is a peptide hormone produced by the anterior pituitary gland and belongs to the family of prolactin-like proteins. It is a single-chain polypeptide that consists of 199 amino acids. The main isoforms of the hormone circulating in the blood are small, large and very large, as well as glycosylated prolactin. Small has a high biological activity, and large and very large - low, these forms of prolactin are characteristic of patients with adenomas, although they can be found in healthy people. Due to the loss of disulfide bonds, large prolactin is able to convert into small one.
Prolactin is produced by lactotrophic cells of the pituitary gland. The secretion of the hormone is influenced by the hypothalamus, the central nervous system, the immune system, the mammary glands, and the placenta are also involved in the production of prolactin. Dopamine, a neurotransmitter produced mainly by the adrenal glands, and its agonists block prolactin secretion, prolactin in turn inhibits dopamine production. In addition, the secretion of prolactin in the pituitary gland is reduced under the influence of the hormones progesterone and somatostatin. These properties are used in the treatment of hyperprolactinemia.
In a woman's body, prolactin stimulates the maturation of the egg, helps to prolong the luteal phase of the menstrual cycle, and affects the developing fetus. The main target organs of the hormone are the mammary glands. Prolactin stimulates the growth and development of the mammary glands, affects the lactation process, promotes the conversion of colostrum into mature milk. In turn, feedback irritation of the nipples stimulates prolactin production.
In the male body, prolactin affects sexual function, the release of sex hormones, and sperm motility. In addition, this hormone belongs to the activators of the growth of new blood vessels. In addition to the mammary glands, prolactin receptors are found in the uterus, ovaries, testes, skeletal muscle tissue, heart, lungs, liver, pancreas, spleen, kidneys, adrenal glands, skin, and some parts of the nervous system, but its effect on these organs has not been studied enough.
The production of prolactin depends on the emotional and physical state, sex life, lactation. The level of the hormone in the blood increases with trauma and stress, as well as with the use of alcohol, narcotic and psychotropic drugs.
Impaired prolactin secretion is one of the most common causes of changes in menstrual function and associated infertility. In women, blood prolactin levels change throughout the menstrual cycle. In addition, daily fluctuations are characteristic of prolactin, with the lowest level of the hormone in the blood observed immediately after waking up, and the peak of production falls on the time interval between 5 and 7 in the morning.
An increase in the level of the hormone is most often diagnosed in women aged 25-40 years. Hyperprolactinemia in men develops much less frequently.
Causes of hyperprolactinemia
The causes of hyperprolactinemia are divided into physiological and pathological. The physiological reasons for the increase in the concentration of prolactin in the blood, in addition to pregnancy and breastfeeding, include:
- exercise stress;
- deep dream;
- sexual intercourse;
- the use of certain products (including alcoholic beverages);
- stressful situations.
These factors cause a short-term increase in the level of prolactin in the blood.
The following conditions contribute to the development of pathological hyperprolactinemia:
- diseases associated with impaired activity of the hypothalamus (tuberculosis, neurosyphilis, malignant neoplasms, severe trauma, etc.);
- prolactin-secreting pituitary adenomas (prolactinomas) - the most common type of pituitary neoplasms;
- hyperfunction of the pituitary gland;
- systemic diseases (rheumatoid arthritis, systemic lupus erythematosus);
- chronic prostatitis;
- ovarian dysfunction;
- chronic renal failure, hemodialysis;
- cirrhosis of the liver;
- shingles;
- trauma (extensive burns, surgery in the chest area);
- artificial termination of pregnancy;
- lack of vitamin B 6 in the body;
- taking a number of medicines (hormonal drugs, antidepressants, antipsychotics, adrenergic blockers); and etc.
Hyperprolactinemia in women often accompanies amenorrhea and infertility, and is also observed in 50% of women with galactorrhea.
Forms of hyperprolactinemia
Depending on the cause, hyperprolactinemia is:
- primary - due to pathological processes in the hypothalamus or pituitary gland;
- secondary - develops against the background of other diseases;
- idiopathic - the mechanism of development cannot be clarified.
In addition, the following forms of pathology are distinguished by origin:
- asymptomatic hyperprolactinemia;
- hyperprolactinemic hypogonadism (prolactin-secreting pituitary adenomas, idiopathic forms);
- symptomatic hyperprolactinemia (alcoholic, medication, psychogenic, neuro-reflex);
- extra-pituitary prolactin secretion;
- hyperprolactinemia against the background of other hypothalamic-pituitary diseases (empty sellar syndrome, hormonally inactive sellar and parasellar neoplasms, cerebral circulation disorder, syphilis, tuberculosis);
- combined forms of hyperprolactinemia.
Symptoms of hyperprolactinemia
In some cases, clinical manifestations of hyperprolactinemia are absent, and an increased level of prolactin in the blood is an accidental diagnostic finding for another reason.
Source: prolactin-info.ru
In women, hyperprolactinemia usually begins to manifest itself clinically with the onset of sexual activity, the use of intrauterine contraceptives, the cancellation of oral contraceptives, after childbirth, artificial or spontaneous abortion, and also at the end of breastfeeding.
Symptoms of hyperprolactinemia in women include menstrual irregularities (irregular menstruation, amenorrhea, oligomenorrhea, hypomenorrhea, bradymenorrhea, opsomenorrhea, spaniomenorrhea), the release of milk or colostrum from the mammary glands in the absence of pregnancy and lactation (galactorrhea). The severity of galactorrhea in women with hyperprolactinemia varies from single drops, which are released with strong pressure on the mammary glands, to abundant spontaneous discharge. The color of the discharge can be white, yellowish, opalescent. In addition, adenomas or cysts can form in the mammary glands.
In patients with hyperprolactinemia, acne, hirsutism (excessive male-pattern hair growth on the body), seborrhea of the scalp, hypersalivation (increased salivation) often appear.
The development of neuroleptic hyperprolactinemia during pregnancy is dangerous by interrupting it in the early or late stages and slowing intrauterine growth and development of the fetus.
The manifestation of hyperprolactinemia can be hypoplasia of the genitals (in particular, the ovaries), dryness of the mucous membrane of the vulva and vagina, which causes discomfort during intercourse, thinning of the hair under the armpits and on the pubis, and a decrease in the mammary glands.
Excessive production of prolactin in men causes a decrease in the level of testosterone in the blood, which causes the development of gynecomastia, galactorrhea, reproductive disorders (including erectile dysfunction, decreased libido). The number and mobility of spermatozoa decreases, pathological forms of spermatozoa appear, which causes infertility. In some cases, retrograde or painful ejaculation is observed.
In patients with hyperprolactinemia, neurological disorders and psychoemotional disorders, disorders of bone tissue metabolism, lipid and carbohydrate metabolism are common. Psychoemotional disorders that accompany hyperprolactinemia are usually manifested by asthenia, indifference, frequent mood changes, memory and attention disorders, psycho-negative disorders, a slowdown in the associative process, increased irritability, a tendency to depressive states, and decreased tolerance (up to autism).
Patients may complain of persistent headaches, attacks of dizziness, decreased visual acuity, narrowing of the visual fields. The nonspecific complaints presented by patients with hyperprolactinemia also include weakness, increased fatigue, nagging chest pains without irradiation and clear localization. Especially often, such signs are observed with the development of an increase in the concentration of prolactin against the background of pituitary neoplasms. In such patients, liquorrhea, inflammation in the sphenoid sinus, diplopia, ptosis, ophthalmoplegia may occur.
Hyperprolactinemia often causes an increase in appetite, which leads to an increase in body weight. In addition, this condition may be accompanied by insulin resistance, a change in the lipid composition of the blood with the development of hypercholesterolemia, an increase in the level of very low and low density lipoproteins and a decrease in high density lipoproteins. This leads to an increased risk of developing coronary heart disease and / or arterial hypertension and type 2 diabetes mellitus.
With prolonged hyperprolactinemia, bone mineral density decreases with the subsequent development of osteoporosis and osteopenia. The loss of bone mineral density can be as high as 3.8% per year. Patients become prone to fractures, in particular, a fracture of the femoral neck, forearm, etc. While maintaining the menstrual cycle in women with hyperprolactinemia and normal estrogen content, bone density does not change.
The manifestations of secondary hyperprolactinemia depend on the disease against which it developed. Irregular bursts of prolactin hypersecretion lead to the appearance of edema, enlargement and tenderness of the mammary glands.
Diagnostics
The main method for diagnosing hyperprolactinemia is to determine the level of prolactin and thyroid hormones in the patient's blood. Blood sampling to determine the concentration of prolactin should be carried out before 10 o'clock in the morning, but not immediately after waking up and not after medical procedures.
Patients should refrain from going to the sauna and having sexual intercourse the day before testing. In women with a preserved menstrual cycle, blood sampling to determine the content of prolactin is carried out between the 5th and 8th days of the cycle. To exclude a temporary increase in the level of this hormone, which is not pathological, repeated tests may be required. It should be borne in mind that stress associated with blood sampling may cause mild hyperprolactinemia in emotionally labile patients.
In order to determine the cause of hyperprolactinemia, they resort to x-ray examination of the skull, computed or magnetic resonance imaging, ophthalmological examination, including examination of the fundus and determination of visual fields. In order to diagnose the uterus and appendages, an ultrasound examination of the pelvic organs is performed. If necessary, other studies are carried out: mammography in women, determination of the level of prostate-specific antigen in men, general and biochemical analyzes of urine and blood, etc.
Treatment of hyperprolactinemia
Treatment of physiological hyperprolactinemia is not required. The tactics of treating hyperprolactinemia of pathological forms depends on its root cause. The goals of therapy for hyperprolactinemia is to reduce the level of prolactin to normal values, restore reproductive and other impaired body functions. The primary task is to eliminate the factor that caused the development of the pathological condition.
Drug-induced hyperprolactinemia requires discontinuation of the drug that caused hormonal disorders. In the event that an increase in the level of prolactin occurred under the influence of taking psychotropic drugs, it may be necessary to reduce the dose of the drug, transfer the patient to a drug that does not have a pronounced effect on the level of prolactin, or add a dopamine receptor agonist to the drug taken.
Drug therapy for hyperprolactinemia includes the use of drugs that suppress prolactin production. In order to restore regular ovulatory menstrual cycles and the ability to conceive, dopamine receptor stimulants are prescribed, the reception of which is indicated before the normalization of the menstrual cycle. In some cases, to prevent the development of relapses, it may be necessary to extend the course for several more menstrual cycles. Restoration of reproductive function against the background of therapy that normalizes the level of prolactin can occur quickly, so women who are not planning a pregnancy need to take care of contraception. In men, along with the normalization of prolactin levels, the testosterone content also normalizes, and erectile function is restored.
In the presence of prolactin-secreting pituitary adenomas, drug therapy is performed. Surgery or radiation therapy for prolactinomas is rarely used, only for macroprolactinomas in case of ineffectiveness of conservative therapy.
With hyperprolactinemia caused by hypothyroidism, thyroid hormone replacement therapy is prescribed, this is enough to normalize prolactin levels in such patients.
Excessive prolactin production in patients with chronic renal failure is usually not corrected by hemodialysis, but, on the contrary, may increase. In this case, the condition returns to normal after kidney transplantation.
If the patient has tumors, cysts, or other growths, surgery and / or radiation therapy may be appropriate. The main indications for hypophysectomy (removal of the pituitary gland) are the lack of a positive effect from conservative therapy and the development of complications from the visual system. In the postoperative period, the question of the appointment of hormone replacement therapy is considered, the need for which is determined by the results of a study of the state of the hypothalamic-pituitary system, determination of the concentration of testosterone and free thyroxine in the blood.
During the treatment of mental disorders that occur in some patients with hyperprolactinemia, difficulties arise with the use of psychopharmacological drugs, most of which help to stimulate the production of prolactin. In this case, in addition to dopamine receptor agonists, antidepressants and anticonvulsants can be used for the treatment of increased anxiety, depressive conditions, and psychovegetative disorders.
Hyperprolactinemia in children
In newborns, a high level of prolactin is a physiological norm; by the end of the first month of life, its concentration in the blood corresponds to that in adults. Outwardly, this is manifested by an increase (swelling) of the mammary glands. After a few months, the content of prolactin in the blood of children decreases.
Hyperprolactinemia in adolescents manifests itself as a delay in sexual development (hypogonadism, constitutional delay in sexual development, etc.). Prolactinoma is often the cause of increased prolactin production in girls. Boys often have an idiopathic form of hyperprolactinemia.
Prevention
There is no specific prevention of hyperprolactinemia, since it can be caused by various factors and diseases. Measures to prevent it consist in prevention, timely identification and elimination of the cause.
General health measures are non-specific preventive measures:
- rejection of bad habits;
- balanced diet;
- regular physical activity;
- avoidance of excessive physical and mental stress;
- normalization of sexual activity, prevention of artificial termination of pregnancy, effective contraception;
- regular preventive examinations.
Consequences and complications
The lack of adequate timely treatment of pathological conditions that caused the development of hyperprolactinemia leads to further endocrine disorders (dysfunction of the thyroid gland, adrenal glands, ovaries, pituitary gland, etc.), infertility, anorgasmia, loss of vision, progression of neoplasms of the hypothalamus and pituitary gland, the development of oncological pathologies of organs reproductive system, and in severe cases, death.
YouTube video related to the article:
Anna Aksenova Medical journalist About the author
Education: 2004-2007 "First Kiev Medical College" specialty "Laboratory Diagnostics".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
