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Hyperprolactinemia – it is an excess of the hormone prolactin in the blood serum, above 25 µg / l. This hormone is normally produced in the anterior pituitary gland, the so-called glandular part. The secretion of the hormone is pulsatile and shows a circadian rhythm, i.e. it changes depending on the time of day, and the highest levels are observed during sleep. The release of the hormone also depends, among others from the meals taken or exercise.
Hyperprolactinaemia is a condition associated with elevated serum prolactin levels. What is prolactin? Prolactin is a hormone that is produced by the cells of the pituitary gland in the middle cranial fossa.
The secretion of this hormone depends on the time of day, the highest concentration can be observed during sleep. How prolactin is released also depends on exercise and the food you eat. In women, this hormone will stimulate the production of food after childbirth, therefore, during pregnancy and breastfeeding, high levels of prolactin in the body are found. In addition, it affects the functioning of the ovaries and testes and the action of hormones in women and men (testosterone and estrogen).
The prolactin concentration should be:
- in women <23 µg / l in the follicular phase (beginning of the menstrual cycle - the first day of menstruation) and <40 µg / l in the luteal phase (the period before the onset of menstruation),
- in men <20 µg / l. (sometimes the values are much higher).
The causes of increased prolactin in the blood
Remember that hyperprolactinaemia is a condition that does not necessarily indicate an underlying medical condition. It happens that a high level of prolactin in the body is associated with pregnancy, breastfeeding, and also has a significant impact on stress, bad experiences or pain. The hormone levels rise when you sleep or eat high-protein meals.
When it comes to the causes – it is worth mentioning the medications you take, which also increase the level of prolactin in the blood. Among such preparations, we can mention drugs: for hypertension, allergy, pain, depression, schizophrenia, ulcers. Be sure to inform your doctor about any medications you are taking, as this may be helpful in diagnosing and finding the cause of hyperprolactinaemia.
Very often, hyperprolactinaemia is caused by a pituitary tumor, a so-called adenoma (benign lesion of the pituitary gland). Most nodules (adenomas) are small and smaller than 1 cm in diameter (microadenomas). A prolactin tumor is rare, about a hundred people per million.
Possible causes of hyperprolactinaemia:
- tumors that secrete prolactin (prolactinoma),
- infiltrative-inflammatory diseases of the hypothalamus,
- side effects of some drugs (including antihypertensive drugs, neuroleptics, antidepressants),
- kidney or liver failure
- injuries of the hypothalamus and pituitary gland,
- decompensated hypothyroidism,
- the presence of an abnormal prolactin molecule
- functional hyperprolactinaemia (periodic excess hormone secretion in response to stimuli such as stress, sleep, sex, nipple irritation),
- pregnancy.
Hyperprolactinaemia – symptoms
The symptoms of hyperprolactinaemia depend on how big the tumor is. Symptoms differ slightly in men and women, but their common element is a disturbance in the work of the gonads, which in turn causes hypothyroidism or ovaries.
In women who have not yet gone through the menopause, symptoms include:
- menstrual disorders (rare or amenorrhea)
- infertility,
- decreased libido,
- galactorrhea (also known as leakage of milk from the nipples)
- hypogonadism,
- hot flashes,
- vaginal dryness
- osteopenii.
In men there is:
- impotence,
- decreased libido,
- sterility,
- gynecomastia (a defect in the form of an enlarged nipple in men),
- hypogonadism (defect of the reproductive system, causes testicular dysfunction),
- osteoporosis,
- reduction of sexual hair,
- decrease in muscle mass.
Macrogruczolaki – these are nodules over 1 cm in diameter, which, due to the pressure on the surrounding tissues, may cause: headaches, visual disturbances (visual field defects) and hypopituitarism (deficiencies of hormones controlling the work of peripheral endocrine glands: the thyroid gland and adrenal glands). important: if you get any of the symptoms above, see your doctor to find out what’s wrong.
Diagnostics of hyperprolactinemia
Specialized tests are needed for the correct diagnosis of a prolactin tumor. After tests showing high levels of serum prolactin, the doctor must first eliminate the woman’s pregnancy; the influence of the preparations used and, by means of the TSH test, hypothyroidism. If these factors are excluded, magnetic resonance imaging using contrast is performed to confirm the presence of the tumor and determine its size. Patients who have slightly elevated prolactin levels are asked to re-test the concentration several times, e.g. every half hour, at night or after taking metoclopramide. The tumor will produce consistently elevated serum prolactin levels regardless of metoclopramide administration.
It happens that some people (especially women) are diagnosed with it functional hyperprolactinaemia – in women who are tested with metoclopramide because they have become infertile, have problems with menstruation and have slightly elevated levels of prolactin, which increase after administration of metoclopramide.
Treatment of hyperprolactinaemia
Treatment depends on the identified cause of hyperprolactinaemia and the presence of clinical symptoms. It is mainly based on pharmacotherapy. Surgery prolactinoma it is reserved for tumors that cannot be treated conservatively or with very poor drug tolerance.
The therapy is aimed at reducing the size of the prolactin tumor and improving the concentration of the hormone in the blood, which is also associated with the proper functioning of the gonads. Drug treatment is mainly based on ingestion dopaminergic drugs, which normalize the level of the hormone and improve the functioning of the testes / ovaries. The following dopaminergic drugs are mentioned:
- cabergoline (the most expensive drug, but not causing side effects as often as bromocriptine, is a newer generation drug and also safer; it can be taken twice a week or less frequently);
- bromocriptine (the preparation is relatively cheap, but may cause side effects in the form of nausea, so it is best to take it at night);
- quinagolide (not the cheapest drug, it causes fewer side effects than bromocriptine).
The listed agents differ in their potency, drug tolerance (occurrence of side effects), half-life and, of course, the cost of treatment. It should be remembered that treatment with pharmacological agents should always be selected individually (not all preparations can be taken by women planning pregnancy). Thanks to drugs, it is possible to achieve normalization of prolactin levels, alleviation or even relief of symptoms and tumor reduction. Surgical treatment (as already mentioned) is performed in the case of tumors that are resistant to pharmacological treatment or when the patient is intolerant to drugs. Removal of the prolactin tumor is done through the nose and sphenoid sinus.
In some situations, doctors undertake periodic treatment of functional hyperprolactinaemia (if other causes of infertility are eliminated), however, treatment should be discontinued when pregnancy is confirmed.
If the doctor decides to stop taking the drugs, the serum prolactin level should be systematically monitored, because the disease may recur longer after the end of therapy.
It happens that in patients who have been taking dopaminergic preparations for many years, the disease goes into remission. In some patients the therapy, in addition to normalizing serum prolactin, also reduces the adenoma, but this may be fatal.
Discontinuation of therapy too early due to euphoria may cause symptoms to recur or even tumor enlargement. In women undergoing fertility treatment, it is important to stop the growth of the tumor before the planned pregnancy.
Appropriate treatment of infertile women often leads to discontinuation of treatment during pregnancy – at this time, the production of prolactin increases, which is the key to the proper development of the breast glands and proper lactation after childbirth. Moreover, cases of spontaneous healing of microadenomas have been described.
Prevention of hyperprolactinemia
There are no known effective ways to prevent the disease.
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