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Women, especially young, professionally active women trying to become pregnant, will sooner or later hear the word “hyperprolactinemia”. This phenomenon is, unfortunately, more and more frequently observed and recognized. The good news is that most often the pharmacological treatment itself brings satisfactory results. When talking about hyperprolactinemia, we are talking about an excess of the hormone prolactin in the blood.
Briefly about prolactin, its function and secretion regulation
It is a hormone that is produced and released from the anterior pituitary gland. Physiologically, its secretion is regulated by dopamine and shows a circadian rhythm. One of the most important roles of prolactin is to stimulate the secretion of milk in the mammary glands of nursing women in the postpartum period. Mechanical irritation of the nipples stimulates the secretion of prolactin. The role of prolactin in the proper functioning of the reproductive system is special, therefore the dysregulation of release mechanisms and its levels, regardless of the cause, is manifested in clinical symptoms. The proper secretion of prolactin, as mentioned above, shows a circadian rhythm, therefore its concentration depends on the time of day. One of the stimuli stimulating its release is sleep, so then higher levels of this hormone are observed. Other physiological stimuli are meals, exercise and emotional state. Severe stress and irregular pores and the length of sleep can lead to disorders of prolactin release. In listing the important causes of physiological hyperprolactinaemia, one cannot fail to mention pregnancy.
Other causes of hyperprolactinaemia
It should be emphasized that hyperprolactinemia is not a disease, but only a symptom of some abnormality. The causes may be more or less difficult to diagnose and further treatment. One of the basic diseases in which the symptom is excess of this hormone in the blood is an anterior pituitary adenoma, which secretes prolactin, i.e. a prolactinoma. It is derived from the lactotropic cells of the glandular pituitary gland and is characterized by an excessive, non-inhibited release of the hormone. Importantly, the symptoms are not limited only to those resulting from the excess of the hormone itself, but also, in the case of a large tumor size, the so-called mass effect symptoms. The pressure of a growing tumor on adjacent structures can cause blurred vision, headaches, and more.
Hyperprolactinaemia can be functional or reactive. We are talking then about periodic, excessive secretion of prolactin in response to various stimuli, such as: stress, sex, exercise, but also hypoglycaemia or sleep.
Damage and injuries of the pituitary gland, hypothalamus or the element connecting both structures, the peduncle of the pituitary gland, which impair the proper functioning and communication of elements of the hypothalamic-pituitary system, may result in hyperprolactinemia.
In addition to the excessive secretion of the hormone, its abnormal metabolism may also appear, as is the case in chronic renal failure or liver failure. Hyperprolactinaemia may accompany decompensated primary hypothyroidism. On the long list of causes, the next place is taken by drugs, among which the following should be mentioned in particular: antidepressants, antihypertensives, neuroleptics, or (e.g. in contraception) estrogens.
Isolated hyperprolactinaemia without correlation of mild clinical symptoms with very high prolactin levels may be due to the presence of an abnormal molecule of this hormone, i.e. macroprolactin.
Hormone levels and the clinical picture
Symptoms with which women most often report to a doctor (mainly a gynecologist) are menstrual disorders or infertility, which, apart from reduced libido, appear already in low-grade hyperprolactinaemia. In the case of severe stage, patients complain of secondary amenorrhea and galactorrhoea, i.e. milk secretion not related to pregnancy. Breast soreness and mastopathy appear. Additionally, depending on the duration and severity of the hormonal disorders, osteopenia or even osteoporosis occurs.
The road to recognition
The multitude of possible causes leading to hyperprolactinemia slightly lengthens the path to diagnosis in a given case. The presence of the above-mentioned symptoms of an excess of prolactin and its determination in the blood start the process of full diagnosis. Further possibilities should be ruled out to focus on looking for a possible pituitary adenoma or other prolactin-secreting extra-pituitary tumor. Especially in the case of high concentrations of the hormone and the presence of features indicating the presence of a tumor, head imaging, magnetic resonance, computed tomography or radiographs should be performed.
The assessment of the level of the prolactin hormone is based on a one-time measurement, several times or regular measurements at half-hour intervals. The assessment of hormone secretion based on the result of an antidopaminergic drug test, during which the secretion of prolactin ceases to be inhibited by dopamine, is diagnostically important. If the prolactin level in the test increases several times (> 6 times), it means that we are dealing with functional hyperprolactinemia. In the presence of adenoma, the increase in prolactin will be only moderate or absent, which forces the search for an autonomous source of hormone secretion that is not subject to physiological regulation.
Conservative or surgical treatment?
The main goal of treatment, apart from removing the underlying cause leading to hyperprolactinaemia, is to normalize the hormone levels and, therefore, restore the proper functioning of the reproductive system. The treatment of choice is pharmacotherapy, which in the vast majority of cases is effective and brings good results. Surgical treatment is reserved for drug-resistant tumors and for the situation of intolerance to conservative treatment. The choice of the drug, its dose and duration of use is always determined with the doctor, with constant monitoring of the response to treatment, such as prolactin levels and the presence of possible side effects. It should be emphasized that the therapy often lasts many years and requires constant monitoring by a specialist.
Hormonal disorders such as hyperprolactinaemia constitute an important clinical problem, the diagnosis and treatment of which depends to a large extent on the patient herself and the time after which she consults the doctor. Often, both the diagnosis and the restoration of the hormonal balance are achieved in a short time. It must not be forgotten, however, that in many cases the underlying process is a proliferative process that requires much more attention.
Text: Katarzyna Kuśmierczyk
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