Hyperprolactinemia – a disease and syndrome associated with a persistent increase in the rate prolactin in the blood plasma. It is characterized by infertility, decreased libido in women and potency in men, weight gain, galactorrhea and a number of other symptoms. Treatment, depending on the root cause, is carried out conservatively or promptly.
Hyperprolactinemia associated with pathological causes occurs in about 17 people per 1000 population. Mostly affected women are in reproductive age. In the general adult population, the average incidence of the disease ranges from 0.15% to 1.5%.
It is important to remember that about 25-30% of married couples visiting the clinic for infertility will end up in a group where one of the spouses has hyperprolactinemia .
Among men who mark erectile dysfunction and are being examined for this reason, the disease is detected in 0.4-20% of cases.
In women suffering from menstrual disorders caused by prolonged irrational use of hormonal contraceptives, an excess of prolactin is determined in 40-60% of cases.
In about 50-70 cases per 1 million, a pituitary tumor secreting this hormone becomes the cause of the development of hyperprolactinemia. In total, prolactinomas account for about 25% of the total number of tumors found in the pituitary gland.
Hyperprolactinemia is divided into two large groups: physiological and pathological.
Physiological form is a variant of the norm and does not require medical intervention. The upward fluctuation of prolactin is quite natural, for example, during pregnancy, during breastfeeding. Also, a jump in the hormone index in the bloodstream is noted in a big way.
- after sex,
- after nipple stimulation (for example, when breastfeeding),
- after physical exertion
- stress also leads to a temporary increase in prolactin levels.
Pathological hyperprolactinemia needs correction under the supervision of a physician. She may be:
- primary, developing on the background of micro- or macroadenomas of the pituitary gland or having an idiopathic (unknown) nature;
- secondary, developing on the background of other diseases of the endocrine nature or somatic diseases;
- iatrogenic, that is emerging on the background of the use of certain drugs (eg, oral contraceptives).
Pathological hyperprolactinemia is a consequence of the influence of a number of reasons. Among the factors that can lead to disease, emit:
- diseases that can disturb the balance in the hypothalamic-pituitary system, the pituitary gland: infections (eg, encephalitis, meningitis), injuries, tumor neoplasms;
- endocrine diseases not directly related to pituitary lesion: primary hypothyroidism type, polycystic ovary syndrome, congenital adrenal hyperplasia type, etc .;
- severe somatic diseases: traumatic injuries of the chest, cirrhotic liver damage, chronic renal failure;
- use of certain drugs: calcium channel blockers, estrogens , verapamil , antidepressants, etc.
Among the factors predisposing to hyperprolactinemia are the same effects as among the causes.
It is important to remember that the overproduction of prolactin inevitably leads to a violation of the emissions of FSH, LH into the bloodstream. As a result, infertility develops.
Prolactin rates differ in men and women:
- adult (not pregnant) women – 64-395mIU / l, or from 4 to 27-29ng / ml;
- adult males – 78-380mme / l or 3-18ng / ml.
In addition, the level of prolactin in women depends on the phase of the menstrual cycle:
- follicular – 252-504 mme / l or 4.5-33ng / l;
- before ovulation – 361-619mu / l or 5-42ng / l;
- luteal – 299-612 mme / l or 4.9-40ng / l.
Symptoms of hyperprolactinemia in men and women differ.
|Reduced sexual desire, erectile dysfunction (occurs from 50 to 80%)||Violation of menstrual function (from 85 to 90%)|
|Gynecomastia (from 6 to 23%)||Infertility due to anovulatory cycles (from 95 to 98%)|
|Insufficient severity of secondary sexual characteristics (from 2 to 21%)||Galactorea (70%)|
|Infertility on the background of oligospermia (from 3 to 15%)||Hirsurtism (male pattern) (from 20 to 25%)|
|Galactorrhea (from 0.5 to 8%)||Acne (from 20 to 25%)|
In about 15% of cases in men, hyperprolactinemia is an accidental finding that is found during examination for other reasons.
In women, the main complaint of hyperprolactinemia is galactorrhea – the release of colostrum in the absence of lactation. It can be both mild (drops appear only when pressing on the mammary gland), and strongly pronounced (full-fledged release of milk).
Among other non-specific symptoms of hyperprolactinemia , with which patients rarely go to the doctor, blaming everything for other existing diseases or fatigue:
- disorders of the sexual spectrum;
- moderate or pronounced obesity;
- bouts of dizziness;
- bradycardia (slow heartbeat);
- emotional spectrum disorders, depressive states.
The main complication of hyperprolactinemia with which patients go to the doctor is infertility. However, if the cause of an increase in the level of prolactin is a pituitary tumor, over time, the patient may experience complaints of reduced vision, up to its complete loss.
Laboratory diagnosis – the main diagnosis of hyperprolactinemia . The main criterion is the determination of the level of prolactin in the patient’s serum. For this a classic blood test is taken from a vein.
According to foreign clinical recommendations, it is possible to diagnose hyperprolactinemia if a single increase in the level of the hormone was detected in the blood serum, but only if the patient is not under stress during the blood collection procedure. According to the Russian recommendations for the diagnosis is recommended to detect at least a twofold increase in the level of prolactin.
Depending on the numbers to which prolactin levels have risen, you can make approximate conclusions about the origin of hyperprolactinemia:
- more than 10,000 iU / l – pituitary macroadenoma ;
- more than 5,000 iU / l – pituitary microadenoma ;
- less than 2000 mU / l – non-tumor origin of hyperprolactinemia .
For the diagnosis of pituitary tumors used MRI of the brain.
Features of differential diagnosis
In the differential diagnosis of hyperprolactinemia , especially if it is confirmed by the analysis of blood serum, difficulties are rarely encountered. The big difficulty is to establish the reason why the level of prolactin in the body has increased. Patients examined for hyperprolactinemia are advised to evaluate the function:
- thyroid gland;
- the liver;
- the kidneys.
It is also necessary to exclude a pituitary tumor, pregnancy in women, taking medications that can lead to a persistent increase in the level of prolactin in the blood. Idiopathic hyperprolactinemia is diagnosed if all somatic diseases, diseases of the endocrine system and tumors that can provoke an increase in the level of prolactin are excluded.
Treatment of hyperprolactinemia is carried out both conservatively and promptly. The treatment is engaged in endocrinologist. The choice of method depends on the reason for the increase in prolactin level.
Conservative therapy is the basis for the treatment of hyperprolactinemia . In terms of the pathogenesis of hormone- producing pituitary tumors, it is most advisable to use dopamine antagonists. On the territory of World use Cabergolin , Hinagolide , Bromocriptine . The question of reducing the dose or completely eliminating the drugs is raised only after a remission of at least 2 years is achieved. Dopamine antagonist drugs can be used not only in the treatment of patients with pituitary tumors. They are also used for idiopathic elevation.
The conservative methods can also include the correction of somatic diseases that can lead to an increase in the level of prolactin. If necessary, the treatment of the underlying disease, the tactics chosen by the doctor depending on the nature of the disease. Correction of prolactin levels in the absence of a tumor varies greatly depending on the cause. Recovery indicator can take from several weeks if the somatic disease was detected in the early stages, up to several years, if the cause is not established or is severely neglected.
Surgical treatment is required for patients suffering from a hormone-producing pituitary tumor resistant to dopamine antagonist drugs. Adenomectomy is performed through the nasal sinuses. If the tumor is large, instead of minimally invasive surgery, transcranial removal directly through the skull is preferred . The rehabilitation period, depending on the type of operation, varies from a month to a year.
In case of pituitary tumors, therapy may be supplemented with chemotherapy and radiation treatment.
The prognosis for hyperprolactinemia depends on many factors. First, it is worth considering the severity of the clinical picture. The brighter it is, the more prognostic this symptom is. Secondly, they rely on the nature of the disease. Hyperprolactinemia caused by somatic diseases has a good prognosis for the treatment of the underlying pathology. With an increase in the level of prolactin due to a tumor after surgical treatment, a relapse of the disease occurs in 25-50% of cases. The most unfavorable are prolactinomas with signs of malignancy .
Specific prophylaxis for hyperprolactinemia is not developed due to the large number of factors capable of causing it.