Scientific editor: Volkov AA, endocrinologist, practical experience since 2015.
June 2019.
Synonyms: hyperprolactinemia, elevated prolactin.
ICD-10 code: E22.1
Hyperprolactinemia - a disease and a syndrome associated with a persistent increase in the indicator prolactin in the blood plasma. Characterized by infertility, decreased libido in women and potency in men, weight gain, galactorrhea, and a number of other symptoms. Treatment depends on the underlying cause, a conservative or operative.
Epidemiology
Hyperprolactinemia associated with pathological causes, occurs in about 17 per 1,000 population. The disease mainly affects women who are of childbearing age. In the general adult population average frequency of occurrence of the disease ranges from 0.15% to 1.5%.
It is important to remember that about 25-30% of couples who come to the clinic for infertility, as a result fall into a group where one of the spouses is sick hyperprolactinemia.
Among men, marking the erectile dysfunction and undergoing a survey on the subject, the disease is detected in 0.4-20% of cases.
Women suffering from menstrual cycle disturbances, caused by prolonged irrational hormonal contraceptives, excess prolactin determined in 40-60% of cases.
Approximately 50-70 cases per 1 million. cause of hyperprolactinemia becomes pituitary tumor secretes this hormone. Prolactinoma only constitute about 25% of the total number of tumors found in the pituitary.
classification of hyperprolactinemia
Hyperprolactinemia is divided into two large groups: physiological and pathological.
The physiological form is a variant of the norm and does not require medical intervention. Fluctuation index of prolactin in the direction of increasing perfectly natural, for example, during pregnancy, while breast-feeding. Also hormone index jump in the bloodstream in a big way celebrated
- After sexual contact,
- teats after stimulation (e.g., breast feeding)
- after exercise,
- Stress also leads to a temporary increase in prolactin levels.
Pathological hyperprolactinemia in need of correction under medical supervision. She may be:
- primary that develops on the background of micro- or macroadenoma pituitary or having idiopathic (unspecified) nature;
- secondary, developing on the background of other diseases of the endocrine nature or physical illness;
- iatrogenic, that is emerging against the background of the use of certain drugs (eg, oral contraceptives).
Causes and risk factors
Pathological hyperprolactinemia - a consequence of the impact of a number of reasons. Among the factors that may lead to disease, is isolated:
- disease, can upset the balance in the hypothalamo-pituitary system, pituitary work: infections (e.g. encephalitis, meningitis), trauma, tumor growths;
- endocrine diseases not directly related to pituitary lesion: primary hypothyroidism type, polycystic ovary syndrome, congenital adrenal hyperplasia type, etc .;
- severe somatic disorders: traumatic injury of the chest, cirrhotic liver disease, chronic renal failure type;
- use of certain drugs: calcium channel blockers, oestrogens, verapamil, antidepressants and others.
Among the predisposing factors hyperprolactinemia appear the same effects as among the reasons.
It is important to remember that overproduction of prolactin leads inevitably breach of FSH emissions, LH in the bloodstream. As a result, developing infertility.
symptomatology
norms of prolactin They differ in men and women:
- adults (not pregnant) female - 64-395mME / l or 4 to 27-29ng / ml;
- adult male - 78-380mME / l or 3-18ng / ml.
Furthermore, prolactin levels in women depends on the menstrual cycle phase:
- follicular - 252-504mME / l or 4,5-33ng / l;
- before ovulation - 361-619mME / l or 5-42ng / l;
- luteal - 299-612mME / l or 4,9-40ng / l.
Symptoms of hyperprolactinemia in men and women differ.
| men | Women |
| Decreased libido, erectile dysfunction (occurs 50 to 80%) | Menstrual dysfunction (from 85 to 90%) |
| Gynecomastia (6 to 23%) | Infertility due to anovulatory cycles (from 95 to 98%) |
| Lack of expression of secondary sex characteristics (from 2 to 21%) | Galactorrhea (70%) |
| Infertility amid oligospermia (3 to 15%) | Girsurtizm (male pattern hair growth) (20 to 25%) |
| Galactorrhea (0.5 to 8%) | Acne (20 to 25%) |
Approximately 15% of cases in men hyperprolactinemia - a chance discovery, which is found during examination for other reasons.
Women with hyperprolactinemia chief complaint is galactorrhea - selection in the absence of colostrum lactation. It can be as mild (drops appear only with pressure on the breast) and strongly expressed (full lactation).
Among other non-specific symptoms of hyperprolactinemia, which patients rarely go to the doctor, writing off all on other underlying disease or fatigue:
- sexual spectrum disorders;
- obesity, moderate or severe type;
- headache;
- dizzy spells;
- bradycardia (heart slowing);
- hypotension;
- emotional disorders personality spectrum, depression.
The main complication of hyperprolactinemia with which patients come to the doctor - infertility. However, if the reason for raising the level of prolactin - pituitary tumor, over time, the patient may receive complaints of reduced vision until its complete loss.
Diagnostics
Laboratory diagnosis - main in the diagnosis of hyperprolactinemia. The main criterion - the determination of the level of serum prolactin levels in a patient. For this shall the classic analysis of blood from a vein.
According to foreign clinical guidelines to diagnose hyperprolactinemia can, if the serum was found edinokratnoe increase in hormone levels, but only if the patient is not experiencing stress during a sampling procedure blood. According to Russian recommendations for diagnosis it is recommended to detect at least two-fold increase in prolactin levels.
Depending on what numbers to increased prolactin levels, it is possible to make approximate conclusions about the origin of hyperprolactinemia:
- more than 10,000 IU \ l - macroadenoma pituitary;
- more than 5,000 IU \ l - microadenoma pituitary;
- at least 2000 IU \ l - non-tumor origin hyperprolactinemia.
For diagnosing pituitary tumors used MRI of the brain.
differential diagnosis Features
The differential diagnosis of hyperprolactinemia, especially if it is confirmed by analysis of serum, difficulties arise rarely. The great difficulty - is to establish the reason for which the level of prolactin in the body increased. Patients are examined on the hyperprolactinemia, it is recommended to evaluate the function:
- thyroid gland;
- liver;
- kidney.
It is also necessary to exclude pituitary tumor, pregnancy in women receiving medicines can lead to persistent increase in blood levels of prolactin. Idiopathic hyperprolactinemia are diagnosed in the event that excluded all somatic diseases, endocrine system diseases and tumors that can provoke an increase in prolactin levels.
Treatment
hyperprolactinemia treatment is carried out both conservative and operative. The treatment takes endocrinologist. Selection of method depends on what the cause prolactin elevation.
conservative
Conservative therapy - the mainstay of treatment of hyperprolactinemia. From the point of view of pathogenesis with hormone-producing pituitary tumors most appropriate use of dopamine antagonists. On the territory of Russia using cabergoline, quinagolide, was bromocriptine. The question of dose reduction or complete abolition of drugs rises only after remission is achieved for at least 2 years. Formulations dopamine antagonists can be used not only in the treatment of patients with pituitary tumors. They are also used in idiopathic increasing index.
By conservative methods also include correction somatic diseases that could lead to increased prolactin levels. If necessary, treatment of the underlying disease is selected tactic doctor depending on the nature of the disease. Correction prolactin level in the absence of a tumor varies greatly depending on the cause. Recovery index can take several weeks, if the physical disease was discovered in the early stages, until a few years, if the cause has not been established or strongly running.
operative therapy
Surgical treatment is required for patients suffering from hormone-producing pituitary tumor resistant to drug-dopamine antagonists. Prostatectomy is performed through the nasal sinuses. If the tumor is large, instead of the minimally invasive surgery prefer transcranial removal directly through the skull. Rehabilitation period, depending on the type of operation varies from a month to a year.
When tumors of the pituitary gland therapy may be supplemented by chemotherapy and radiotherapy.
Prediction and prevention
The prognosis for hyperprolactinemia depends on many factors. Firstly, it is necessary to take into account the severity of the clinical picture. The brighter, the more prognostically unfavorable this feature. Secondly, based on the nature of the disease. Hyperprolactinemia caused by physical illnesses, it has a good prognosis with treatment of the underlying pathology. At higher levels of prolactin due to tumor recurrence after surgical treatment of the disease occurs in 25-50% of cases. The most unfavorable considered prolactinoma with signs of malignancy.
Specific prophylaxis for hyperprolactinemia is not developed due to the large number of factors that can cause it.
