Hyperprolactinemia: causes, symptoms and treatment
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Hyperprolactinemia is a condition in which the level of hormones — prolactin levels are higher than normal. Because of prolactin in breast cancer in women produce milk needed to feed an infant, so prolactin also called «milk hormone.» This hormone is synthesized in the anterior pituitary, and its formation is controlled by the hypothalamic releasing factor. Prolactin is formed in both women and men but in the latter in a smaller amount.
In the female body, the role of prolactin is not only to milk production and release him from the chest. «Milk hormone» responsible for the growth and development of the mammary glands, suppresses the production of the follicle-stimulating hormone, which leads to the blockade of ovulation, reduces the formation of estrogen and progesterone, thus providing contraceptive effect and prevents the occurrence of menstruation during breastfeeding. Furthermore, prolactin has anesthetic action and promotes orgasm. On the level of prolactin in the body is influenced by not only releasing factors of the hypothalamus, and thyroid hormones, estrogens, and other factors.
Norms of prolactin: Hyperprolactinemia
Standards prolactin levels in the blood are relative and depend on the particular laboratory and received her standards:
- The average level of the hormone is not greater than 15 ng / mL
- male — prolactin from 1 to 18 ng / ml;
- Women — hormone levels from 1 to 27 — 28 ng / ml.
Depending on the phase of the menstrual cycle of prolactin in blood is different:
- follicular phase — 4.5 — 33 ng / l;
- periovulyatornaya — 5 — 42 ng / ml;
- luteal — 4.9 — 40 ng / ml.
- Types of hyperprolactinemia
There are several types of hyperprolactinemia:
- physiological hyperprolactinemia is not associated with pathological conditions (pregnancy, breastfeeding, tension, sleep, coitus, heavy exercise, etc.);
- pathological hyperprolactinemia caused by disease and, in turn, divided into organic and functional:
- Organic caused tumors of the pituitary gland and the hypothalamus;
- functional due to diseases of other organs;
- pharmacological hyperprolactinemia occurs while taking certain medications;
- idiopathic hyperprolactinemia has no cause and is characterized by increased function of pituitary cells in their normal amount.
Causes of hyperprolactinemia
Physiological factors increase prolactin levels in the blood are: the period of gestation, breastfeeding, neonatal period, nipple stimulation, sleep (regardless of the time of day), intake of protein foods, overwork and stress, physical activity, the second phase of the menstrual cycle, reduced sugar blood, surgical intervention.
By pathological causes of hyperprolactinemia include:
- Diseases and tumors of the hypothalamus, pituitary tumors (prolactinoma, cyst, adenoma, etc.), pathology of other organs (liver cirrhosis and liver failure, hypothyroidism, systemic diseases, polycystic ovaries, chronic prostatitis, etc.).
- Increased prolactin levels observed at the reception: estrogens Oder Ath contraceptive pills, antiemetics, drugs that suppress the production of dopamine (methyldopa, verapamil), antipsychotics (chlorpromazine) and others.
Symptoms of hyperprolactinemia
Clinical signs in hyperprolactinemia may like to have a place, and absent. As a rule, elevated prolactin levels in the blood is detected by accident when handling the woman to the doctor about other symptoms. The clinical picture of this condition includes impaired fertility, metabolic problems in sexual life and violations of emotional and mental state.
Characteristic features of hyperprolactinemia are irregular menstruation and galactorrhea. Usually, cycle disorders are expressed in amenorrhea, oligomenorrhea and the absence of ovulation, which is 30% the cause of infertility. But in some women of prolactin excess amount does not affect the menstrual cycle.
Galactorrhea or the milk from the nipple is observed in 70% of cases. Galactorrhea is classified by degree:
- 1 degree — from the nipple colostrum is released in the case of breast palpation;
- 2 degree — the milk is allocated jet palpation the chest;
- 3 degree — the milk is running stream spontaneously, and there alone.
In addition to menstrual irregularities, and galactorrhea, patients with hyperprolactinemia have difficulties in their sexual life. There is the decrease in sexual desire, pain during intercourse, vaginal dryness, anorgasmia, frigidity. The mucosa of the urethra and vaginal atrophy, found hirsutism, acne, seborrhea and thinning hair. In severe cases, there is an involution of mammary hypoplasia of the uterus, breast, or breast cancer.
In the case of pituitary tumors possible compression of the optic nerves, which appears blurred vision and visual field loss. There have been changes in the emotional sphere in the form of depression, irritability, weakness, fatigue, memory loss and other.
Treatment of hyperprolactinemia
Treatment of hyperprolactinemia conducts medical drugs, surgery or radiation therapy. The method depends on the clinical manifestations, causes increased prolactin and effectiveness of a particular method. Because of drugs used drugs that inhibit the secretion of prolactin and activate dopamine receptors. These include bromocriptine (Parlodel) and quinagolide. Treatment of these drugs not only to normalize prolactin levels but also helps to reduce pituitary tumor.
In the case of existing hypothyroidism prescribe drugs thyroid hormones. If the effect of the drug treatment is absent or drugs are not tolerated, carried out an operation — the removal of pituitary tumors through the nasal passages. Surgery complementary radiotherapy.