Diagnosis of hyperprolactinemia

Hyperprolactinemia, also known as hyperprolactinemia, is a syndrome of reproductive-endocrine disorders of the hypothalamus-pituitary axis caused by various reasons, characterized by elevated serum prolactin and its related clinical manifestations. It is a general term for a class of common clinical diseases that can affect the reproductive, endocrine and nervous systems.

Functional and organic tumors should be distinguished in the etiology diagnosis of patients with hyperprolactinemia. Clinicians should exclude physiological and drug factors through careful history collection, physical examination, hormone level measurement and imaging examination, clarify the source of high prolactin levels and whether there are pathological causes and give corresponding treatment. 1. History collection Ask the suspected patient for a detailed medical history, especially to understand the patient's possible relevant medical history from the three aspects of physiological, pathological and pharmacological hyperprolactinemia. Ask in detail whether there is oligomenorrhea, amenorrhea and luteal insufficiency, understand the time of lactation, menstrual history, delivery and breastfeeding history, surgical history and past medical history; ask whether there is a history of taking antipsychotic drugs, sedatives, antiemetics, gastrokinetic drugs, antihypertensive drugs or contraceptives; whether there are thyroid, kidney, chest wall and other diseases. Whether there is a stress state such as hypoxic exercise, exercise, sexual intercourse, anesthesia, pain, hypoglycemia, surgery, nipple stimulation, mental and emotional fluctuations or pelvic examination when blood is collected for hormone measurement. Primary examinations 1. Physical examination Whole body examination Pay attention to vision, abnormalities of fingertips, obesity, hypertension, hirsutism and chest wall lesions. Pelvic examination Pay attention to genital development, atrophy or pelvic mass Breast examination Pay attention to galactorrhea, whether it is unilateral or bilateral, milk characteristics and milk secretion. The milk collected is milk if fat droplets can be seen under a low-power microscope. 2. Blood PRL level determination The best time to collect blood is 9-11 am in a quiet state. PRL greater than 25up/L is high PRLemia. If the PRL value is greater than 50ug/L, the incidence of pituitary microadenoma is about 25%. When the PRL value is greater than 250up/L, the possibility of pituitary macroadenoma is high. 3. Imaging blood test Pituitary microadenomas can be found through enhanced magnetic resonance imaging and enhanced computed tomography.

Secondary examinations 1. Visual field examination: Pituitary tumors may invade or compress the optic chiasm, resulting in visual field defects. Visual field defects may range from classic, complete bitemporal hemianopsia to small partial quadrant defects or dark spots. 2. Gynecological ultrasound to observe the uterine shape, size and ovarian abnormalities.