Hyperprolactinemia is a condition of the body that is characterized by an increase in the content of the prolactin hormone (PRL) in the blood. Hyperprolactinemia occurs in the form of a physiological (during pregnancy, in newborns, in the process of lactation) and pathological form. When a high content of PRL in the blood is detected after a single analysis, one can not say with accuracy about hyperprolactinaemia. The very fact of a venipuncture, a visit to a doctor can provoke stressful transient hyperprolactinemia.
The disease is much more common among women, but can develop in men. In addition, prolactin can exist in various molecular formulas, so they select the so-called big-prolactinemia, which does not belong to pathology and does not require treatment. Such a state proceeds without specific manifestations and, as a rule, is detected completely by accident.
Pathological hyperprolactinaemia is essential (primary) and acts as an independent form of hypothalamic-pituitary disease. And also they release symptomatic hyperprolactinemia, which is a sign of other pathologies and conditions. Essential hyperprolactinemia is characterized by the development of the syndrome of hyperprolactinemic hypogonadism, during which women develop pathological galactorrhea, the menstrual cycle (amenorrhea) is disrupted, and in men, potency decreases, oligospermia develops and rarely galactorrhea and gynecomastia.
Syndrome giperprolaktinemii formed due to various disorders, such as somatogenous, endocrine and neuro-psychic. The causes of hyperprolactinaemia can be of a physiological nature, pathological and pharmacological. For the physiological characteristic of the release of prolactin in the process of physical exertion, stressful situations, sleep, sexual intercourse and the reception of food rich in proteins. Prolactin is produced against the background of physical exertion, at the moment of reaching the anaerobic threshold. This hormone is considered to be stressful, although its effectiveness during mental or psychological stresses has not been fully demonstrated. Concentration of PRL increases in the blood with stressful factors, which are accompanied by hypotension or syncope. These reactions are responsible for the increase in the hormone that is observed during venipuncture. Also, hypoglycemia is a powerful stimulus for the formation of prolactin, both among women and men.
Among the pharmacological reasons for the development of hyperprolactinaemia, many drugs that disrupt metabolism, synthesis, absorption or dopamine binding by receptors that reduce its effectiveness and cause increased secretion of prolactin are isolated. These drugs include Domperidone, Phenothiazine, Pimozide, Butirofen, Reserpine, Decorboxylase, Methyldopa.
The powerful stimulants for the production of human prolactin include opioids of endogenous properties.
In addition, the formation and production of PRL by the action of estrogens is enhanced. They, with the use of pharmacological doses, cause an increase in PRL in women and men with simultaneous suppression of FSH and LH in the blood.
The occurrence of hyperprolactinaemia can be directly influenced by various pathological diseases. It is the tumors of the hypothalamus, tuberculosis , histocytosis, germinomas, sarcoidosis , craniopharyngiomas of the suprasellar region and gliomas that cause the pseudophysis leg recapitulation syndrome. And its irradiation helps to reduce synthesis and release of dopamine, and prolactin - to increase.
Among the most common causes of the formation of hyperprolactinaemia is adenoma of the pituitary gland. It is a benign tumor that produces prolactin. Prolactinomas can have different sizes, but mostly up to 10 mm, and are called microprolactinomas. And the rest are called macroprolactinomas with a tumor size of more than 10 mm.
Hyperprolactinaemia of functional etiology develops as a result of insufficient thyroid function, chronic kidney failure, cirrhosis, polycystic ovary syndrome. Hyperprolactinaemia can occur as a consequence of surgical interventions and various chest injuries, as well as frequent processes of curettage of the uterus.
Sometimes an increase in the level of prolactin can occur without any apparent cause. This form of hyperprolactinemia is called idiopathic. It is characterized by increased work of the pituitary cells, in which their number may slightly increase or remain normal.
The clinical symptoms of various forms of hyperprolactinaemia vary in their course. The age of women under which the prolactinoma develops is 25-30 years old, and in men it is 45-50 years. Among the most persistent causes of women's treatment of a gynecologist with prolactinomas is infertility and menstrual irregularity. Such disorders can range from opsoligomenorei to amenorrhea, which acts as a secondary pathology. But the symptoms of polymorphism are uncharacteristic for hyperprolactinemia.
In many patients, the symptoms of menarche are somewhat delayed and occur for 14-15 years. Almost every fifth patient is diagnosed with irregular menstruation from the beginning of menarche. Then such menstrual irregularities are clearly observed at the time of often repeated stresses.
As a rule, amenorrhea begins to develop simultaneously with such signs as the onset of sexual activity, the abolition of previously used contraceptives, the period of pregnancy, the process of delivery, the manipulation of intrauterine contraceptives or the implementation of surgical interventions. There are no symptoms in the form of hot flashes, and the primary signs of amenorrhea are very rare.
In 20% the first symptom of hyperprolactinemic hypogonadism (GG) is galactorrhea, but in rare cases it is a complaint of patients. Galactorrhea can vary from spontaneous copious discharge to single drops when applying strong pressure. With prolonged course of hyperprolactinemia, the galactorrhea becomes smaller as a result of replacement of the glandular tissue by fatty tissue, which is explained by the duration of hypoestrogenemia.
The main complaint of patients is the primary or secondary form of infertility, as well as miscarriages in the first half of pregnancy. The majority of people with decreased libido, dryness of the vagina, frigidity, 80% moderate obesity . In 25% there is a significant growth of hair on the face, along the white line of the abdomen and in the region of the nipples. With a microadenoma, as well as with the development of the Turkish saddle, frequent headaches are noted in terms of migraine and dizziness. Signs of a subjective and objective nature are expressed in violation of the work of the optic nerves, especially in men. Some patients are prone to emotional and personal disorders, as well as to depression. This may be due to a change in the content of hormones in the body and biogenic amines. During the examination, bradycardia and hypotension are recorded, therefore, hypothyroidism should be excluded. The mammary glands are presented in the form of a soft consistency with involutive changes. In amenorrhea of the primary type, the mammary gland has pale nipples, which, as a rule, are retracted and flat. Very rarely develop macromastia and gigantomastia.
With giperprolaktinemii possible hypoplasia of the uterus, there are no symptoms of "pupil" and "tension" of mucus. Patients who fell ill during the preubertal period, are diagnosed with clitoral hypoplasia and small labia. Today, with early diagnosis, there are more women without pronounced signs of internal genital hypoplasia. Occasionally, even enlarged ovaries, which have small-cystic degeneration, are detected.
Symptomatic of hyperprolactinemia in men is associated, as a rule, with such symptoms as decreased libido and impotence. Gynecomastia and galactorrhea are very rare among them. Hyperprolactinemia develops as a consequence of the pituitary macroadenoma, so patients have symptoms associated with the loss of tropic pituitary hormones and a tumor inside the skull (68% are headaches and 65% are visual impairments).
Hyperprolactinemia in men
This disease is a hypersecretion of prolactin and the causes that cause the development of hyperprolactinaemia in men can be diverse and can be divided into several groups.
Firstly, these are various diseases that lead to disruption of the hypothalamus. These include infections such as encephalitis, meningitis ; processes of granulomatous and infiltrative character: tuberculosis, histiocytosis, sarcoidosis, etc .; various tumor pathologies: germinoma, craniopharyngioma, meningioma, glioma , etc .; trauma associated with rupture of the pituitary foot, hemorrhage in the hypothalamus, blockade of vessels, neurosurgery, irradiation; metabolic disorders - a chronic kidney failure and cirrhosis of the liver.
Secondly, these are peculiar lesions of the pituitary gland, which manifest themselves in the form of prolactin, mixed somatotropic-prolactin adenoma, other tumors (gonadotropinoma, tirotropinoma, corticotropinoma), turkish saddle syndrome, craniopharyngioma, hormone-inactive adenoma, Rathke's pouch, meningioma and intrasellar germinoma.
Thirdly, hyperprolactinemia in men can provoke hypothyroidism of the primary etiology and ectopic hormone secretion, as well as damage to the chest.
Fourth, various drugs can cause this disease in men. These include blockers of the hormone dopamine; antidepressants; Verapamil, which blocks calcium channels; adrenergic inhibitors; blockers of H2 receptors; Cocaine and opiates; Tyroliberin.
In men, prolactinoma in comparison with women occurs in a ratio of 1: 8. In general, hyperprolactinemia occurs simultaneously with the macroadenoma. But microadenomas are detected in men in rare cases. As a rule, this is due to late diagnosis of pathology.
When X-ray examinations can detect deformities of the Turkish saddle. Disturbances in the regulation of the hypothalamus due to reduced dopamine formation or increased prolactoliberin production cause hyperplasia of lactotrophs with the further formation of microadenoma and macroadenoma. Sometimes hyperprolactinemia in men is formed against the background of the adenoma of the pituitary gland, which squeezes the hypothalamus, the pituitary foot and breaks the secretion of prolactostatin. In such patients, the prolactin level in the blood is fixed on the numbers 25-175 ng / ml, and with prolactinomas - 220-1000 ng / ml. If the values of prolactin are more than two hundred, then this indicates a tumor of the pituitary gland.
Symptomatic hyperprolactinemia in men manifests itself in the form of impotence and a decrease in libido, which at the beginning of the disease are perceived as a consequence of psychogenic factors. Very often, patients are diagnosed with psychogenic impotence. But to confirm the diagnosis it is important to make an exception of hyperprolactinemia. Sometimes this disease occurs against a background of gynecomastia with changes in the testicles as a reduction and softening. About 25% of men suffer from lactorrhoea with varying degrees of severity. There is also osteoporosis , although to a lesser extent, unlike women.
A characteristic symptom of male hyperprolactinemia is headache caused by macroadenoma in the pituitary gland. Other symptoms include a violation of visual acuity and tropic functions of the anterior part of the pituitary gland.
Treatment of hyperprolactinaemia is to determine the cause that contributed to the development of the disease, and then in the appointment of appropriate therapy. But the main thing is to reduce and normalize the increased production of prolactin, to reduce the size of the pituitary tumor, to correct lactorrhea and hypogonadism , to restore vision and work of cranial nerves when they are disturbed.
Hyperprolactinemia in women
This is a condition in which there is an increase in PRL (prolactin) in the blood. This is possible with physiological hyperprolactinemia and anomaly of this disease (pathological), which can become a signal of severe pathologies.
The main causes of the appearance of hyperprolactinemia in women are physiological, which include pregnancy and the entire term after childbirth, and for non-breastfed women it is from one to seven days; irritation of the nipples and newborn; sleep, sexual intercourse, eating and stress. Pathological reasons include: diseases of the hypothalamus and the pituitary foot; various diseases of the pituitary gland (adenomas, craniopharyngomas, hypothyroidism, malignant tumors with metastases, tuberculosis, sarcoidosis); various surgical interventions with the use of general anesthesia; cirrhosis and 75% chronic kidney failure, as well as chest pathology in the form of burns, shingles . In addition, the use of certain drugs may contribute to the formation of hyperprolactinaemia. Basically, these are drugs that block dopamine receptors; reduce the level of dopamine (Reserpine, Methyldopha, Verapamil, etc.), oral contraceptives and phenothiazines.
Functional hyperprolactinemia in women can be observed with various gynecological diseases, such as endometriosis, uterine myoma and inflammatory processes. This is due to the constant processes of stimulation of interoceptors against the backdrop of pathological process and impulses in the central nervous system as a result of the chronic form of endogenous stress. In recent decades there has been transient hyperprolactinemia, which often accompanies infertility and is characterized by the effect of prolactin on the yellow body.
Hyperprolactinemia of a functional nature is observed in many women with PCOS, as a consequence of dopaminergic control of prolactin.
However, the most common causes of hyperprolactinaemia in women are still considered micropropactinoma and pituitary hyperplasia.
The symptomatology of the disease is made up of some manifestations, namely, in 15% there is amenorrhea, which leads to infertility. There is also a galactorrhea associated with a pathological spontaneous outflow of milk, which is not a process of breastfeeding. However, with this sign, the level of prolactin in most patients can be normal, which is explained by transient hyperprolactinemia, which has passed into a resistant galactorrhea.
Typical symptoms of the disease are hyperestrogenism, dyspareunia and decreased libido, as well as osteoporosis in the background of a long course of the disease. Then in women, vision deteriorates, as a result of the development of the tumor of the pituitary gland and its increase, which compresses the optic nerve. When delaying sexual development, an appropriate study is needed to check the level of TSH. Sometimes hyperprolactinaemia occurs with hyperandrogenia.
Recently, with hyperprolactinaemia, 35% of women have an increased number of adrenal androgens. In addition, it is proven that they decrease when used in the treatment of Bromocriptine.
Hyperprolactinaemia and pregnancy
During pregnancy, a therapeutic technique for prolactin is of particular interest, since hyperprolactonemia may also develop for other reasons. In this case, patients can observe other specialists and prescribe the treatment of the underlying disease, among which may be pituitary adenomas, infiltrative-destructive or tumor lesions of the Turkish saddle, hypothalamus, Itzenko-Cushing's disease , etc. But the hyperprolactinemic state does not need a certain correction in functional hyperprolactinaemia during stress.
Almost 40% of infertility is associated with the pathology of the endocrine system. Moreover, hyperprolactinemia refers to one of the frequent causes of endocrine infertility. Therefore, in order to restore fertility, and also lead a pregnancy with hyperprolactinemia syndrome, a thorough examination of patients is necessary. And for today, hyperprolactinaemia and pregnancy are an important reproductive health problem on the whole planet.
Physicians diagnosed with hyperprolactinemia, speaks of infertility of women as a result of high rates of prolactin. But if the pregnancy occurs with this disease, the woman is always under the control of specialists and continues to take Parlodel, which regulates the production of the hormone and significantly reduces the relapses of prolactinoma. This drug will allow the child to endure without complications. Also, patients during pregnancy with hyperprolactinemia should periodically consult with a neurologist and ophthalmologist.
In addition, it is important to remember that with physiological hyperprolactinemia, prolactin in the blood rises from the eighth to the twenty-fifth week of pregnancy, as well as during breastfeeding of the baby. But before childbirth, he falls somewhat.
To begin with, it is important to exclude primary hypothyroidism. And for this purpose, thyroid preparations are prescribed under the supervision of an endocrinologist and, thanks to such therapy, the level of PRL usually decreases.
Hyperprolactinemia caused by pituitary hyperplasia or micropropactinemia, and if no further pregnancy is planned in the future and with missing violations of the menstrual cycle, is under the supervision of doctors. But for cycle disorders, substitution therapy in the form of hormones is prescribed.
Among the main drugs that are used to treat hyperprolactinaemia, Parlodel (Bromocriptine), which is an ergot derivative, is secreted. This drug is able to suppress the secretion of the hormone prolactin, activating the receptors of dopamine and its release. Bromocriptine is prescribed at 1.25 mg per day, and then every three weeks is added in the same amount even overnight, and every fourth week afterwards and in the morning with mandatory control of the PRL in the blood. However, this drug categorically can not be taken with pathological abnormalities of the liver. Bromocriptine is canceled after two or three years from the beginning of admission. In addition, a control ultrasound is administered six months and a year after the prolactin level is normal. As a rule, the recovery of ovulation occurs from the fourth to the eighth week of treatment.
In the absence of pregnancy after the recovery of the menstrual cycle, possibly with various peritoneal factors of infertility or laparoscopy. Parlodel sometimes causes the development of side effects in the form of nausea, dizziness, weakness, fainting, nasal congestion and even constipation.
For the treatment of hyperprolactinaemia, some treatment regimens with a longer duration of action are used: Cabergoline, Turgurid and Lizurid. And also Dihydroergocryptin and Metergoline with fewer side effects and low efficacy.
Bromocriptine is used to treat macroprolactinoma, which significantly reduces the size of the tumor process (by 30%). And then spend every six months MRI to exclude a possible increase. In addition, during pregnancy and while breastfeeding it can be taken in small cycles. It was found that patients with a diagnosis of pituitary microadenoma, taking during pregnancy Pärloderm, safely tolerate it. The risk of tumor formation as a result of pregnancy can be avoided, previously treated with Parlodel for more than one year. Also, medical scientists proved that this drug is safe for a pregnant woman, and for her future child.
With hyperprolactinemia of a functional nature with various gynecological diseases, primary treatment of the underlying disease is carried out first. Then, if a pregnancy is planned in the future, Parlodel is prescribed in small doses with blood control for prolactin and basal temperature measurements. In the syndrome of polycystic ovaries, Parlodel treatment is used to stimulate ovulation and the drug is canceled when pregnancy occurs.
Therapy of the primary form of hypothyroidism begins with a doctor-endocrinologist. In this case, appoint Thyreocombe, L-thyroxine and Thyreoidin. As a rule, this treatment will be quite long and with mandatory control of hormones in the blood, as well as the general condition of the patient. When there is excitability, irritability, crying, palpitations of tremors, it is necessary to reduce the dose of drugs.
The healing process restores the patients' well-being, normalizes ovulation with the menstrual cycle and stops lactation. During pregnancy, it is important to continue taking thyroid medications, because hypothyroidism is the cause of infertility and various fetal malformations.
With ineffective treatment with Bromocriptine, as well as with the progression of gipreprolactinemia, for example, with violation of the visual fields, a surgical method of treatment is prescribed. Although he also can not prevent the occurrence of relapses of pathology.
Access to the operative field is carried out through the sinuses of the nose to remove the tumor tissue. Surgical intervention is performed only in a specialized clinic, to prevent various serious complications, such as paralysis of the oculomotor nerve, meningitis, internal carotid artery injury, etc. During the operation, Bromocriptine therapy is discontinued, as this drug helps to tighten the tissue, and this interferes with surgical intervention .
The operation is considered to be successful in normalizing the level of PRL two hours after its completion and when restoring ovulation for forty days.
The consequences of hyperprolactinemia may be different. First, they are complications in the form of development of pituitary insufficiency and other organs of the endocrine system. Therefore, it may be necessary to prescribe hormone therapy for correction, for example, the thyroid gland, adrenal glands, etc. Secondly, the optic nerve can be squeezed. After that, the fields of vision decrease, the vision deteriorates sharply or the sight is completely lost until the squeezing effect of the tumor is eliminated. Thirdly, it is an osteoporosis with a long process without treatment. And the last complication of gipreprolactinemia may be malignancy of tumors, which will require urgent hospitalization and the appointment of radiation or surgical irradiation.
Hyperprolactinaemia is a disease in which the help of a qualified specialist is necessary, therefore one can not treat this condition on its own, as it can be the consequence of serious pathologies and lead to disastrous consequences.
There are no specific preventive measures. Hyperprolactinemia, simply as a condition, does not need certain rehabilitative measures with the use of sanatorium-and-spa treatment.
Certain diets and nutrition is not required. But the psychological and emotional overstrain, as well as the physical, are unacceptable.
In addition, oral contraceptives are absolutely contraindicated, since they promote prolactin in the blood. There is also evidence that intrauterine devices affect the increase in PRL. This fact is explained by the fact that there is a constant irritation of the endometrium. Therefore, it is necessary to choose either sterilization, or contraceptives with pure gestagens, as well as prolonged ones, such as Depot Provera.
Hyperprolactinaemia is characterized mainly by a favorable prognosis. In clinical observation, patients with pituitary prolactinoma need to prevent relapses. For this, it is necessary to undergo a CT scan once a year, visit the oculist and do a blood test twice a year for the quantitative content of prolactin.